Category: Ankle; Trauma Introduction/Purpose: Ankle fractures are among the most common injuries that Orthopaedic Surgeons treat; yet, little guidance exists in postoperative protocols for ankle fractures concerning time of immobilization and weightbearing. Results from previous studies have been mixed; demonstrating improved outcomes, no difference in outcome, or poorer outcomes including increased wound complications in patients who are mobilized early. Here, we aim to investigate the association between early immobilization and patient reported outcomes. Our null hypothesis was that no difference in PROMIS scores would be identified in patients when comparing the effect of time of immobilization and time of weightbearing. Methods: A chart review identified ankle fractures that underwent surgical fixation between 2015 and 2020 at a level 1 trauma center and its associated facilities. One-hundred nineteen patients from 8 providers met inclusion criteria for our final analysis. Fifty patients were immobilized for <6 weeks and 69 patients were immobilized for at least 6 weeks. Our primary outcome measures included the PROMIS questionnaire, time of immobilization, and time to full weightbearing. Our secondary outcome measures included time to return to work, wound complications (infection, delayed healing), and complications associated with fracture fixation (loss of reduction, delayed union, reoperation, hardware failure). Repeated-measures ANOVAs were used to predict each of the PROMIS outcomes of anxiety, depression, physical function, and pain interference. Each model included the predictors of age, sex, race, BMI, payor, provider, time to radiographic union, time to return to work, time to full weightbearing, and early vs late immobilized groups. Results: There were no differences in PROMIS scores between mobilization groups and time to full weightbearing (p>0.05). Furthermore, there were no differences in wound complications nor complications associated with fracture fixation (p>0.05). Across our cohort, physical function scores were negatively impacted by higher BMI, increasing age and longer time to return to work/play (p<0.05). Our analysis further showed that depression, anxiety, pain interference and physical function levels improve as a function of time (p<0.05). African Americans showed more pain interference than other groups of patients (p<0.05). No difference in PROMIS scores were identified between treating providers (p>0.05). Conclusion: In this study, the null hypothesis was accepted. Data from our analysis shows no significant differences between the early and late mobilization and weightbearing groups in terms of PROMIS outcomes nor with wound complications and complications associated with fracture fixation. Our study does suggest that early mobilization after operative treatment of ankle fractures is safe and results in similar patient reported outcomes with no increased risk of complication. We did find that African American patients experienced more pain that other groups and we aim to further explore this topic to find potential modalities to address this disparity.

Category: Ankle Arthritis; Ankle Introduction/Purpose: The utilization of total ankle arthroplasty (TAA) is increasing in treatment of end-stage ankle arthritis. Modern implants show improved survival at 10-year and greater follow-up with patient reported outcomes exceeding those obtained with arthrodesis.1-5 Other benefits include maintaining ankle range of motion and decreased rate of adjacent joint arthrosis. The Infinity (Stryker, Mahwah, NJ), Salto-Talaris (Salto) (Smith & Nephew, Memphis, TN), and Scandanavian Total Ankle Replacement (STAR) (DJO Global, Lewisville, TX) TAA have become highly utilized implants due to minimal bone resection to preserve both tibial and talar bone stock. The purpose of this study is to determine implant survival, reoperation rate, and patient reported outcomes of minimal-resection total ankle implants. Methods: After obtaining IRB approval, a retrospective review was performed of all patients who underwent TAA between January 1, 2007 - December 31, 2018. Inclusion criteria, including minimum 2 year follow-up, and exclusion criteria left ninety- eight (98) patients for review. Primary outcome measures included patient-reported outcome measure information systems (PROMIS) scores preoperatively, 1-year and last follow-up. Secondary outcomes measures included reoperation and need for revision surgery as well as radiographic analysis at 3-months, 1-year, 2-year, 5-years and last follow up to identify loosening and lucency. Demographics including age, gender, race, body mass index (BMI), smoking status and diabetes were tabulated. Student's T-test compared PROMIS outcomes between the Infinity and Other groups. Chi-squared test investigated differences in categorical variables and a repeated-measure analysis of variance (ANOVA) was used to investigate differences between PROMIS scores for the Infinity group. Results: 75 Infinity and 23 STAR or Salto patients were identified, average follow up of 3.4 years (range of 5-months to 10.75- years). PROMIS scores for depression and anxiety were significantly lower at most recent follow-up for the Infinity group (p<0.05). Physical function and pain interference scores were not significantly different between groups (p>0.05). Infinity patients saw favorable improvements in anxiety, depression, physical function and pain interference scores postoperatively (p<0.05). A higher incidence of revision with Salto and STAR was observed when compared to Infinity (1 Infinity, 1 Salto, 4 STAR) (p<0.05). Salto and STAR groups presented more 5-year cysts than the Infinity group (p<0.05). Evidence of loosening was higher in the Infinity group at 5-years compared to Salto and STAR (1 Infinity, 0 Other, p<0.05). Finally, more lucency zones were identified at 3 months in Infinity group compared to Salto and STAR (p<0.05). Conclusion: TAA is a durable treatment for ankle osteoarthritis demonstrating equivalent physical function and pain inference PROMIS scores across all minimal resection implants. Patients who received Infinity had significant improvements in depression and anxiety PROMIS scores when compared to other implants at an average 3.4 year follow-up suggesting significant improvement in quality of life as measured by PROMIS between the preoperative and early/late term follow-up periods. Patients who underwent TAA with Infinity experienced lower rates of revision and a trend toward lower need for reoperation when compared to other minimal resection implants.