From the Geisinger Medical Center, Department of Orthopaedics, MSK Institute, Danville, PA (Dr. Friedman and Dr. Horwitz); the Universidad del Rosario, School of Medicine and Health Sciences, Bogota, Colombia (Dr. Sanchez); the Department of Orthopaedic Surgery, University of California Davis Health System, Sacramento, CA (Dr. Zachos); Department of Orthopedic Surgery, Lahey Hospital and Medical Center, Burlington, MA (Dr. Marcantonio); Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI (Dr. Audet); Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH (Dr. Vallier); Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN (Dr. Mullis); University of Miami, Department of Anesthesiology, Jackson Memorial Hospital, Miami, FL (Dr. Myers-White); Department of Orthopaedic Surgery, Carolinas Medical Center, Atrium Health Musculoskeletal Institute, Charlotte, NC (Dr. Kempton); and Department of Orthopedic Surgery, Cleveland Clinic Akron General Hospital, Akron, OH (Dr. Watts).
J Am Acad Orthop Surg Glob Res Rev. 2021 May 11;5(5):e21.00074. doi: 10.5435/JAAOSGlobal-D-21-00074.
Ankle fractures are one of the most prevalent musculoskeletal injuries, with a significant number requiring surgical treatment. Postoperative complications requiring additional interventions frequently occur during the early postoperative period. We hypothesize that there is a limited need for routine clinical and radiographic follow-up once the fracture is deemed healed.
IRB approval was obtained at four academic trauma centers. A retrospective chart review was done to identify adults with healed unimalleolar and bimalleolar ankle fractures treated surgically with at least 12 months of follow-up. Based on postoperative radiographs, changes in fracture alignment and implant position from radiographic union to final follow-up were documented. The average reimbursement for a final follow-up clinic visit and a set of ankle radiographs were estimated.
A total of 140 patients met inclusion criteria. The mean age at injury was 49.5 years, and 67.9% of patients were female. The mean time to healing was 82.2 days (±33.5 days). After radiographic healing, one patient had radiographic changes but was asymptomatic and full weight bearing at their final follow-up. On average, our institution was reimbursed $46 to $49 for a follow-up clinic visit and $364 to $497 for a set of ankle radiographs.
Given the average time to healing, there is limited utility in routine radiographic and clinical follow-up beyond 16 weeks in asymptomatic patients. In our series, this would result in a savings of $950 to $1,200 per patient. However, after ankle fractures were deemed healed, 0.7% patients had radiographic evidence of a change in implant position. Documenting this change did not modify the immediate course of fracture treatment. Surgeons will need to balance the need for routine follow-up with the potential economic benefits in reducing costs to the healthcare system.
踝关节骨折是最常见的肌肉骨骼损伤之一，其中相当一部分需要手术治疗。术后早期经常会出现需要额外干预的并发症。我们假设一旦骨折被认为已经愈合，就不需要常规进行临床和影像学随访。
在四个学术创伤中心获得了 IRB 批准。进行了回顾性图表审查，以确定接受手术治疗且至少有 12 个月随访的愈合的单踝和双踝踝关节骨折的成年人。根据术后 X 光片，记录从 X 光愈合到最终随访时骨折对线和植入物位置的变化。估计最终随访诊所就诊和一组踝关节 X 光片的平均报销费用。
共有 140 名患者符合纳入标准。受伤时的平均年龄为 49.5 岁，67.9%的患者为女性。愈合的平均时间为 82.2 天（±33.5 天）。在 X 光愈合后，有 1 名患者的 X 光片发生变化，但在最终随访时无症状且完全负重。平均而言，我们的机构为每次随访诊所就诊报销 46 至 49 美元，为一组踝关节 X 光片报销 364 至 497 美元。
鉴于平均愈合时间，在无症状患者中，在 16 周后进行常规影像学和临床随访的实用性有限。在我们的系列中，这将为每位患者节省 950 至 1200 美元。然而，在踝关节骨折被认为已经愈合后，0.7%的患者的 X 光片显示植入物位置发生变化。记录这一变化并没有改变骨折治疗的即时过程。外科医生需要在常规随访的需求与减少医疗系统成本的潜在经济利益之间取得平衡。
