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New foot and ankle nonunion risk assessment tool developed
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San Francisco — Researchers recently presented a new tool designed to assess the risk of nonunion for patients undergoing foot and ankle surgery.
“Quantitative nonunion risk assessment is a novel and valuable tool to better estimate the degree of patient risk,” Gowreeson Thevendran, MD, and colleagues wrote in their abstract.
Thevendran presented the assessment at the American Academy of Orthopaedic Surgeons Annual Meeting.
The researchers surveyed international foot and ankle experts online to identify patient and surgical risk factors for nonunion. Those surveyed were asked to rate the significance of each risk factor on a scale of one to 10, using smoking one pack a day as a benchmark rating of five. The investigators then stratified the risk factors into one of three categories: more significant than smoking one pack a day, factors no different than smoking one pack a day or less significant than smoking one pack a day.
To test the tool, the researchers performed a retrospective case cohort study that compared 22 patients with ankle and hindfoot fusion nonunions from the Canadian Foot and Ankle Society Database to 40 controls matched for age, gender and pathology. The control group had a score of 6.6 vs. 13.5 for the nonunion group. The data showed a high interclass correlation coefficient ranging between 0.90 and 0.97 and a high intraclass correlation coefficient ranging from 0.80 to 0.93, according to the abstract. The investigators assessed the discriminatory potential of the risk assessment tool using a receiver operating characteristic curve that showed an area under the curve of 0.77. Multivariate logistic regression showed that a lack of fusion site stability and increased body mass index were the most predictive risk factors for nonunion.
“This is not by any means a revolutionary method,” Thevendran said. “It is experimental. It is new. It is perhaps not even ready for clinical assessment, but it does have potential in terms of allocation of resources and comparison of different treatment modalities. – by Renee Blisard Buddle
Reference:
- Thevendran G, Wang C, Younger AE, Pinney SJ. Nonunion risk assessment in foot & ankle surgery: Proposing a new predictive risk assessment model. Paper #449. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
For more information:
- Gowreeson Thevendran, MD, can be reached at Tan Tock Seng Hospital, Singapore; email: xanthus23@hotmail.com.
- Disclosure: Thevendran has no relevant financial disclosures.