Comparing Patient Communication Event Demand for External Ring Fixators to Other Common Foot and Ankle Orthopaedic Procedures: A Retrospective Study.

Background: Surgeons may hesitate to apply external ring fixators (ERFs) due to perceived high clinical burden. This study aims to quantify the relative demand of ERFs compared with other common foot and ankle procedures. Understanding the demand of ERFs can provide insights into postoperative experiences, potentially decreasing intimidation of their use.

Methods: Patients undergoing ERF treatment, hallux valgus osteotomy (HVO), or lateral ligamentous reconstruction (LLR) were identified using current procedural terminology code search in a single surgeon database. A retrospective review at a single institution included patients undergoing one of the three surgeries between 2017 and 2023. Clinical burden was quantified using points of contact for each procedure, which included phone calls, portal messages/documented emails, in-person visits, and surgeries. Visits and surgeries were categorized as routine or unexpected. Quantified burden was then compared among the three groups.

Results: One hundred ninety-four patients were included in the study (81 LLR, 64 HVO, 49 ERF), and data were collected within 6-month postoperation. ERFs had 2.27 more total clinic visits than HVO (6.91 vs. 4.64; P < 0.0001) and 2.80 more than LLR (6.91 vs. 4.11; P < 0.0001). Overall, 0.42 more unexpected clinic visits were observed for ERF than for HVO (0.94 vs. 0.52; P = 0.06) and 0.84 more than LLR (0.94 vs. 0.1; P < 0.0001). An average of 0.6 unexpected surgeries were observed for ERF, compared with 0.09 for HVO (P < 0.0001) and 0 for LLR (P < 0.0001).

Conclusion: Patients with an ERF did have more frequent encounters compared with control groups. This study provides guidance about the extent of potential clinical burden of ERF. Whether this increase is clinically notable would be to the discretion of the treating surgeon.