Browsing by Author "Loder, Randall"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Iatrogenic Peroneal Nerve Palsy Rates Secondary to Open Reduction Internal Fixation for Tibial Plateau Fractures Using an Intraoperative Distractor
    (Wolters Kluwer, 2020-01) Pattyn, Ryan; Loder, Randall; Mullis, Brian H.; Orthopaedic Surgery, School of Medicine
    Objective: To report the rate of peroneal nerve palsy after routine use of intraoperative distraction during open reduction internal fixation (ORIF) for lateral unicondylar and bicondylar tibial plateau fracture (TPF) repairs. Design: Retrospective chart review Setting: Level I trauma center Patients: Patients with traumatic TPF treated with ORIF between 2007 and 2017 Intervention: ORIF for lateral unicondylar and bicondylar TPF. Main Outcome Measurement: Presence and resolution of neurovascular injury Results: There were a total of 21 lateral unicondylar and 40 bicondylar TPFs repaired via ORIF in 60 patients identified during the study period with one year follow up and complete records for review. Thirty-six patients had staged external fixation prior to ORIF while 24 were treated with ORIF initially. Of the staged patients, 9 of 36 (25%) developed nerve palsy while those undergoing initial ORIF (not staged) developed palsy in only one case (1 of 24, or 4%). Of the patients who developed nerve palsy 9 of 10 (90%) were staged with an initial external fixator prior to ORIF. The incidence of iatrogenic peroneal nerve palsy secondary to intraoperative distraction was 16.4% (10 of 61). Only 60% (6 of 10) of peroneal nerve palsies recovered clinically with a mean recovery time of approximately 14 weeks. Comparison of demographics in patients with peroneal nerve palsy versus those without yielded no significant difference by sex (p = 0.08), age (p =0.27), fracture type (p = 0.29), tobacco use (p = 0.44) or alcohol use (p = 0.78). Conclusions: Peroneal nerve palsy is a common sequela of ORIF for TPFs involving the lateral compartment utilizing an intraoperative distractor. Staged external fixation followed by definitive ORIF using intra-operative distraction, was associated with significant risk for developing nerve palsy (9/10). Many patients (40%) who develop peroneal nerve palsies do not recover, leading to permanent loss of motor and/or sensory function for 7% of patients studied. None of the epidemiologic variables evaluated yielded predictive value for development of peroneal nerve palsy or subsequent resolution. Caution should be exercised in avoiding over distraction when using intraoperative distraction, especially in those cases that had staged fixation, most notably bicondylar injuries.
  • Thumbnail Image
    Item
    Overlapping Surgery for Ankle Fractures: Is It Safe?
    (Wolters Kluwer, 2020-08) Baessler, Aaron; Mullis, Brian; Loder, Randall; Corn, Karsen; Mavros, Charles; Orthopaedic Surgery, School of Medicine
    Objective: To determine whether the practice of overlapping surgery influenced patient safety after open reduction internal fixation (ORIF) for ankle fractures. Design: Retrospective case–control. Setting: Level 1 Academic Midwest trauma center. Patients: All patients who underwent ankle fracture ORIF by a single surgeon were eligible for our study, with 478 total patients. Intervention: Cases that were overlapping were compared against cases that were not overlapping. Cases were defined as overlapping if there was greater than 30 minutes of overlap between procedural times. Patient complications were recorded up to a year from the index surgery. Main Outcome Measure: Unexpected return to surgery. Results: There were 478 ankle fracture ORIF patients, 238 with at least 3 months follow-up; 124 (52%) in the overlapping group and 114 (48%) in the nonoverlapping group. There was no difference in the rate of unexpected return to surgery (P = 0.76), infection (P = 0.52), readmission (P = 0.96), painful implant (P = 0.62), malunion (P = 0.27), nonunion (P = 0.52), or arthritis (P = 0.39) between the overlapping and nonoverlapping groups. There were 467 isolated ankle fractures used for time analysis. Average procedure time was 26 minutes longer for the overlapping group than the nonoverlapping group (P < 0.01). Conclusions: Overlapping surgery causes increased operative time for ankle ORIF, but there was no apparent increased risk to the patients for short-term complications. The need for graduated resident responsibility required by ACGME guidelines need to be weighed against the decreased efficiency of operating room time.