title: Perioperative vitamin D levels correlate with clinical outcomes after ankle fracture fixation.
abstract: BACKGROUND
  Hypovitaminosis D is common in patients undergoing orthopaedic trauma surgery. While previous studies have shown that vitamin D levels correlate with functional outcome after hip fracture surgery, the significance of vitamin D levels on outcomes after surgery in other orthopaedic trauma patients is unknown. The purpose of this study was to determine if vitamin D levels correlated with outcomes in ankle fracture patients.
  
  
  METHODS
  We reviewed a prospective registry of patients who underwent operative treatment for ankle fractures from 2003 to 2012. Preoperative serum 25-hydroxyvitamin D (25[OH]D) levels were measured, and the primary and secondary outcomes included foot and ankle outcome scores (FAOS) and ankle range of motion. Data were also collected on patient comorbidities, articular malreductions, and wound complications. Included patients had at least 12 months of clinical outcome data.
  
  
  RESULTS
  Ninety-eight patients operatively treated for ankle fractures met our inclusion criteria. Of these 98 patients, 36 (37%) were deficient in vitamin D (<20 ng/ml) and 31 (32%) had vitamin D insufficiency (<30 ng/ml, ≥20 mg/ml). Patients with vitamin D deficiency were similar with regard to age, gender, and comorbidities compared to patients with vitamin D levels ≥20. Univariate analysis revealed that patients with vitamin D deficiency had significantly worse FAOS with regard to symptoms (P = 0.017) and quality of life (P = 0.040) domains than patients with vitamin D levels ≥20. Multivariate regression analysis suggested that vitamin D deficiency was a factor in inferior FAOS with regard to symptoms, activities of daily living, and quality of life.
  
  
  CONCLUSIONS
  In our group of patients with operative treated ankle fractures, preoperative vitamin D deficiency correlated with inferior clinical outcomes at a minimum of 1 year follow-up. Our study suggests that deficient vitamin D levels may result in worse outcomes in orthopaedic trauma patients recovering from fracture fixation.
authors.affiliation: Orthopaedic Trauma Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA. warners@hss.edu.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Warner
authors.affiliation: Orthopaedic Trauma Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Garner
authors.affiliation: Epidemiology and Biostatistics, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Nguyen
authors.affiliation: Orthopaedic Trauma Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.|Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Dean G
authors.initials: DG
authors.lastname: Lorich
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000453:epidemiology / Q000601:surgery*; D000843:Ankle Joint / Q000503:physiopathology; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: Ankle fracture; FAOS; Outcomes; Vitamin D