Contact: Richard Cantrall 800.235.4855
Doug Cavarocchi
For Release 17 July 1997
MONTEREY - Basic logic tells us making two surgical repairs in one operation is more cost-effective than performing each repair separately. A study presented today at the American Orthopaedic Foot and Ankle Society's 13th Annual Summer Meeting reveals that in some cases this "doubling-up" is not only cost-effective, it leads to better healing and greater patient satisfaction as well.
Researchers in Idaho examined the cost-effectiveness of performing a fusion (arthrodesis) of the sub-talar (below the ankle) joint immediately following the surgical repair of heel bone (calcaneal) fractures. They discovered that performing these operations in the same operative session with this patient group led to more complete healing and less pain for the patient.
The study specifically examined patients who had suffered severe heel fractures on the job, generally from a fall of ten to twelve feet. These fractures involving several breaks in the bones (comminuted fractures) are repaired with a surgical procedure called open reduction internal fixation (ORIF).
"Our study shows that even after ORIF of calcaneal fractures these patients continue to have many problems -- they continue to hurt, they develop arthritis," explained Michael J. Coughlin, MD, Clinical Professor of Orthopaedic Surgery, Oregon Health Sciences University, and author of this study. "Many patients later have an arthrodesis or fusion procedure performed at increased expense to the insurer and the patient."
Dr. Coughlin went on to explain that for these types of severe fractures, ORIF procedures alone are often not enough to leave the patient with a painless functional foot. Greater than 80 percent of the patients examined in this study who received only ORIF suffered moderate or severe activity restrictions at follow-up, 40 percent could walk no more than six city blocks, and 40 percent required a change in job status. Eleven of the 22 ORIF only patients went one to either have arthrodesis performed or had been recommended to receive the procedure to alleviate these symptoms.
Based on the overall cost of two successive procedures and the time lost from work in recovering from two separate surgeries, this paper suggests that consideration be given to simultaneous arthrodesis and ORIF at the same operative sitting for more severe fractures of the heel. Dr. Coughlin explained, "The cost to insurers would be essentially the same, the time off work and recovery time for the patient would be the same as for just an ORIF procedure, and by performing procedures simultaneously we eliminate the need for arthrodesis surgery to alleviate symptoms in the future -- as was required by over 40 percent of our study group."
This study was done at the request of the State Insurance Fund, the major surety for worker's compensation injuries in the State of Idaho, in the hopes of establishing procedures that allow the best use of state insurance and worker's compensation funds and protect the health of industrial patients.
Dedicated to advancing research and educational objectives in foot and ankle care, the American Orthopaedic Foot and Ankle Society is the leading organization for orthopaedists with a special interest in foot and ankle problems.
- 30 - Press and patient information available at http://www.aofas.org
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