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No link found between aspiration of ankle fractures and pain relief
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TAMPA, Fla. — Level 1 research presented here showed aspiration of acute ankle fractures did not lead to diminished pain or decreased usage of pain medication in patients compared with placebo.
“We found no significant differences between aspiration and control groups at any time point. We found no differences in secondary [outcomes],” S. Andrew Sems, MD, said. “Based on this finding, we conclude that aspiration of isolated acute ankle fractures within 24 hours of injury does not provide any measurable clinical benefit and cannot be recommended as a standard adjunctive therapy for ankle fracture.”
Sems presented the findings of the prospective, randomized, double-blinded, placebo-controlled trial at the Orthopaedic Trauma Association (OTA) Annual Meeting. He and his colleagues enrolled 124 skeletally mature patients with isolated, closed OTA 44 fractures who presented for treatment within 24 hours of injury and were randomized to undergo either aspiration of the ankle hemoarthrosis or a sham procedure. In the sham procedure, the needle was inserted subcutaneously, held in place for a silent count of 10 and then removed. No fluid was aspirated. A curtain prevented patients in the control group from seeing the sham procedure.
S. Andrew Sems
The primary study outcomes included the Numeric Rating Scale (NRS) pain scores and narcotic usage, which was recorded by patients in customized pain diaries and then converted to oral morphine equivalents for analysis. The study was designed to detect a 1.5 difference in the NRS score, indicating a clinically significant change.
The groups were similar in terms of baseline demographics. Investigators found the groups also had comparable pain scores on arrival to the emergency department and at discharge as well as change in pain score. In addition, the study showed similar pain scores 96 hours after discharge with no significant differences between the groups at any time points. The total amount of opioid medication used in the first 96 hours from injury were the same between the groups and there was no significant difference between the groups’ narcotic usage at any time in the first 4 days from injury.
“There was no difference in the 6-month Olerud-Molander scores, and there was no difference in the [short-form musculoskeletal assessment] SFMA scores at 6 months,” Sems said. “Complications were rare, and there was no difference in the complication rates between the groups.” – by Gina Brockenbrough, MA
Reference:
Sems SA. Paper #31. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 16-18, 2014; Tampa, Fla.
For more information:
S. Andrew Sems, MD, can be reached at Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minn. 55905; email: sems.andrew@mayo.edu.
Disclosure: Sems receives royalties from Biomet for work related to hip fracture technology. He has no disclosures related to ankle fractures.