From the Department of Orthopaedic Surgery, Stanford Health Care, Stanford, CA.
J Am Acad Orthop Surg. 2019 Aug 15;27(16):607-612. doi: 10.5435/JAAOS-D-18-00630.
Increased overlap in the scope of practice between orthopaedic surgeons and podiatrists has led to increased podiatric treatment of foot and ankle injuries. However, a paucity of studies exists in the literature comparing orthopaedic and podiatric outcomes following ankle fracture fixation.
Using an insurance claims database, 11,745 patients who underwent ankle fracture fixation between 2007 and 2015 were retrospectively evaluated. Patient data were analyzed based on the provider type. Complications were identified by the International Classification of Diseases, Ninth Revision, codes, and revision surgeries were identified by the Current Procedural Terminology codes. Complications analyzed included malunion/nonunion, infection, deep vein thrombosis, and rates of irrigation and débridement. Risk factors for complications were compared using the Charlson Comorbidity Index.
Overall, 11,115 patients were treated by orthopaedic surgeons and 630 patients were treated by podiatrists. From 2007 to 2015, the percentage of ankle fractures surgically treated by podiatrists had increased, whereas that treated by orthopaedic surgeons had decreased. Surgical treatment by podiatrists was associated with higher malunion/nonunion rates among all types of ankle fractures. No differences in complications were observed in patients with unimalleolar fractures. In patients with bimalleolar or trimalleolar fractures, treatment by a podiatrist was associated with higher malunion/nonunion rates. Patients treated by orthopaedic surgeons versus podiatrists had similar comorbidity profiles.
Surgical treatment of ankle fractures by orthopaedic surgeons was associated with lower rates of malunion/nonunion when compared with that by podiatrists. The reasons for these differences are likely multifactorial but warrants further investigation. Our findings have important implications in patients who must choose a surgeon to surgically manage their ankle fracture, as well as policymakers who determine the scope of practice.
Level III-retrospective cohort study.
骨科医生和足病医生的执业范围重叠增加，导致足病医生对足踝损伤的治疗增加。然而，文献中比较踝关节骨折固定后骨科和足科结果的研究很少。
使用保险索赔数据库，回顾性评估了 2007 年至 2015 年间接受踝关节骨折固定的 11745 名患者。根据提供者类型分析患者数据。并发症通过国际疾病分类，第九版，代码识别，通过当前程序术语代码识别修订手术。分析的并发症包括畸形愈合/不愈合、感染、深静脉血栓形成，以及灌洗和清创的发生率。使用 Charlson 合并症指数比较并发症的风险因素。
总体而言，11115 名患者由骨科医生治疗，630 名患者由足病医生治疗。从 2007 年到 2015 年，由足病医生治疗的踝关节骨折手术比例增加，而由骨科医生治疗的比例下降。所有类型的踝关节骨折中，足病医生手术治疗与更高的畸形愈合/不愈合率相关。单踝骨折患者的并发症无差异。在双踝或三踝骨折患者中，由足病医生治疗与更高的畸形愈合/不愈合率相关。与足病医生相比，由骨科医生治疗的患者具有相似的合并症特征。
与足病医生相比，骨科医生治疗踝关节骨折的手术与较低的畸形愈合/不愈合率相关。这些差异的原因可能是多因素的，但需要进一步研究。我们的发现对必须选择外科医生治疗踝关节骨折的患者以及确定执业范围的政策制定者具有重要意义。
三级-回顾性队列研究。
