2015 ISAKOS Biennial Congress ePoster #132

Trends in Arthroscopy Associated with Ankle Fracture Treatment

Jakob Ackermann, MD, Zurich SWITZERLAND
Ethan J. Fraser, MBBS, New York, NY UNITED STATES
Payal Desai, MPH, New York, NY UNITED STATES
Khushdeep Vig, BS, New York, NY UNITED STATES
Christopher D. Murawski, MD, Pittsburgh, PA UNITED STATES
John G. Kennedy, MD, FRCS, New York, NY UNITED STATES
Hospital for Special Surgery, New York, NY, USA

FDA Status Not Applicable

Summary: . Despite recent recommendation for the use of arthroscopy at the time of fracture treatment for the detection of OCL in ankle, only 1% of patients undergoing ORIF treatment for acute ankle fracture were arthroscopically evaluated simultaneously.

Abstract:

Purpose

The purpose of this article was to quantify the number of ankle arthroscopies that were performed concomitantly with open reduction and internal fixation (ORIF) of ankle fractures in the United States, and to evaluate the number of concomitantly performed microfracture treatments in these cases. We also sought to identify the prevalence of ankle arthroscopies that occurred as a subsequent procedure after ORIF or closed (with or without manipulation) treatment for an ankle fractures within a 7-year follow-up period.

Method

The current procedural terminology (CPT) billing codes were used to search the PearlDiver Patient Record Database and identify all patients who were treated for acute ankle fracture in the United States. The Medicare Standard Analytical Files were searchable between 2005-2011 and the United Healthcare Orthopedic Dataset from 2007-2011. Among this group, patients who underwent arthroscopy, particularly arthroscopic microfracture/drilling concomitantly to ORIF of the ankle joint, were evaluated. Further, the prevalence of ankle arthroscopy subsequent to ORIF or closed treatment for an ankle fracture was assessed and quantified within a period of 7 years. Annual trends were expressed between 2007-2011, as it was the common time period amongst both databases. Demographic factors were identified for all procedures.

Results

In total, 32,307 patients underwent ORIF of an ankle fracture, of whom 313 (1.0%) had an ankle arthroscopy performed simultaneously. Of those 313 cases, 70 (22.4%) patients received microfracture treatment. Patients were significantly more likely to undergo microfracture at time of ORIF than to undergo microfracture arthroscopically as a subsequent treatment (p=0.0113). The prevalence of concomitant arthroscopic treatment increased significantly by 177% from 2007 to 2011 (p<0.0001).
Between 2005 and 2011, 85,203 patients were treated for an ankle fracture whether via ORIF or closed treatment in the United States. Of these, a total of 566 patients underwent arthroscopic treatment within 7 years, significantly more often females (p<0.0001) and patients younger than 65 years of age (p<0.0001). The prevalence of arthroscopy after ankle fracture decreased significantly by 45% from 2007 to 2011 (p<0.0001).

Discussion

Microfracture was frequently used in patients undergoing arthroscopy simultaneously to open fracture treatment in the United States. Despite recent recommendation for the use of arthroscopy at the time of fracture treatment for the detection of OCL in ankle, only 1% of patients undergoing ORIF treatment for acute ankle fracture were arthroscopically evaluated simultaneously. There was, however, seen to be a significant decrease of subsequent arthroscopic procedures after ankle fracture, while also a significant increase in the rate of concomitant ankle arthroscopy during ankle fracture treatment. This may be the results of earlier detection and treatment of OCLs in patients with ankle fractures.