BOFAS News & Events

This pages lists all the latest news and upcoming events.

 

To access 'Foot Print' (the BOFAS Bulletin) please click here (members only)

 

Latest News

Togay Koç
/ Categories: Abstracts, 2017, Podium

Assessing the risk factors in the management of diabetic ankle fractures: can rigid-long segment fixation (RISF) improve outcomes

R. Ahluwalia, F. Rhamen, V. Kavarthapu

Introduction: Diabetes is a poor prognostic indicator after an ankle fracture. Many surgeons avoid operating due to concerns regarding complications.

Method: We performed a retrospective analysis of complication rates for acute ankle fractures in diabetics with a control non-diabetic patient treated by all surgeons in our unit and assessed factors for success including long-segment fixation. Patient records were cross-referenced with departmental databases and a review of all ankle fractures managed in our department was conducted from 2012. All patients subjected to a retrospective-review of their follow-up for at least 6-months. Radiographs were assessed of the ankle before and at completion of treatment being reviewed independently (RA & FR). We identified the HB1Ac (diabetic-control) and systematic co-morbidities. Fractures were classified into unimalleolar, bi malleolar and trimalleolar and surgery grouped into standard or long-segment-rigid fixation. Statistical analysis was conducted using absolute/relative risk (RR); numbers needed to treat (NNT) were calculated. We compared a control-group, a diabetic group managed conservatively, and undergoing surgery; comparing the concept of rigid fixation and prolonged imobilisation in isolation or combined. Further sub-analysis conducted assessing diabetic neuropathy, retinopathy and nephropathy. Ethics approval was granted as per our institutional policy by our governance lead.

Results: We identified 154 diabetic ankle fractures, seventy-six had conservative-treatment; 78 had operative fixation of which 23 had rigid-long-segment-fixation. The diabetic-groups had a higher risk-relative-risk of complication - 3.2 (P< 0.03) being linked to systematic complications of diabetes e.g. neuropathy 5.8 (P< 0.003); HBA1c 4.6 P< 0.004); and neuropathy or retinopathy 6.2 (P< 0.0003). Relative-risk reduction of complications occurred following surgery with prolonged immobilization (0.86) and rigid-fixation (0.65). The Number-Needed-to-Treat required to see a benefit from rigid fixation was 7.

Conclusions: Diabetics have a higher risk for complications, however the risk is not as great as previously reported. We provide evidence of rigid-long-segment-fixation with prolonged-immobilization improving outcomes.

 

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Tags: AnkleFractureDiabetes

 

BOFAS Hosted Events

This courses is designed to develop and extend the knowledge and skills of training foot and ankle surgeons. Techniques of arthroscopic surgery of the joints, ligaments and tendons of the ankle and foot will be presented and demonstrated. Basic Skills covers the more common procedures which a foot and ankle surgeon would be likely to need. Delegates will be given ample time to develop their skills in each of the areas listed below using cadaver limbs. Questions and case presentations will be encouraged with an expert and interactive faculty.

Anterior ankle
Posterior ankle 
Haglund’s surgery
Sub-talar joint
Tendoscopy
Arthroscopic Ankle fusion
1st MTP joint

 

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This courses is designed to develop and extend the knowledge and skills of established foot and ankle surgeons. Techniques of arthroscopic surgery of the joints, ligaments and tendons of the ankle and foot will be presented and demonstrated. Advanced Skills covers some more advanced and emerging techniques. Delegates will be given ample time to develop their skills in each of the areas listed below using cadaver limbs. Questions and case presentations will be encouraged with an expert and interactive faculty.

1st MTP joint
Arthroscopic lateral and medial ligament repair FHL transfer
Peroneal groove and Tibialis posterior
Tarsal coalition excision
Sub-talar fusion
Chopart joint fusion

 

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BOFAS Principles Course Taunton

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These courses are aimed at Higher Surgical Trainees / ST3 onwards and are designed to teach the core of Foot and Ankle surgery in an informal and interactive environment. The emphasis is on clinical examination cases, discussion groups and typical day-to-day clinic scenarios. Although not an exam preparation course, content is taught to the standard expected in the FRCS(Tr & Orth) exam; that of a day-one non-specialist orthopaedic consultant. Applications will open on 1st September 2023.

Venue - Taunton (TBC)

 

 

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BOFAS Supported Events

Other Upcoming Events / Courses