title: [Unexpected revision procedures treating ankle fractures].
abstract: The purpose of the present study was to analyze the risk factors associated with unexpected second procedures and strategies of revision surgery. Within a 5 year period 647 patients with closed ankle fractures AO type 44 were identified of which 77 (11.9%) needed revision surgery. Complications were addressed to 4 main groups: deep infections (IG) were seen in 29 patients (4.5%), problems with primary wound closure (WG) in 22 patients (3.4%), insufficient reduction (KG) in 22 patients (3.4%) and other causes (RG) included 4 patients (0.6%). Significant predictive factors for soft tissue complications were higher age, comorbidities with peripheral arteriosclerosis, high American Society of Anesthesiologists (ASA) score and diabetes mellitus. AO 44 type B2 and B3 fractures were often associated with soft tissue problems. The more complex fracture types AO 44 C1-C3 and A2-A3 were significantly associated with problems of insufficient congruency post-surgery. The distribution of the mean revision rate was significantly different (p<0.01) for all groups: IG 4.59, WG 3.5, KG 1.55, RG 1.25. In summary, we strongly recommend immediate reduction of displaced fractures and to consider a more detailed fracture classification. To reduce the amount of unexpected ankle procedures individual risk factors should be weighed against the advantages of optimal open reduction and internal fixation.
authors.affiliation: Abteilung für Orthopädie und Unfallchirurgie, Marienhospital, 45886, Gelsenkirchen, Deutschland. jens.richter@rub.de
authors.forename: J
authors.initials: J
authors.lastname: Richter
authors.forename: A
authors.initials: A
authors.lastname: Pommer
authors.forename: R
authors.initials: R
authors.lastname: Breuer
authors.forename: S
authors.initials: S
authors.lastname: Hullmann
authors.forename: D V
authors.initials: DV
authors.lastname: Heyde
authors.forename: A
authors.initials: A
authors.lastname: Dávid
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000453:epidemiology* / Q000601:surgery*; D001178:Arthroplasty / Q000706:statistics & numerical data*; D005260:Female; D005593:Fracture Fixation, Internal / Q000706:statistics & numerical data*; D005596:Fractures, Closed / Q000453:epidemiology* / Q000601:surgery*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D013639:Tarsal Bones / Q000293:injuries*; D016896:Treatment Outcome; D055815:Young Adult