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Perioperative vitamin D levels correlate with clinical outcomes after ankle fracture fixation

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Hypovitaminosis D is common in patients undergoing orthopaedic trauma surgery. While previous studies have shown that vitamin D levels correlate with functional outcome after hip fracture surgery, the significance of vitamin D levels on outcomes after surgery in other orthopaedic trauma patients is unknown. The purpose of this study was to determine if vitamin D levels correlated with outcomes in ankle fracture patients.

Materials and methods

We reviewed a prospective registry of patients who underwent operative treatment for ankle fractures from 2003 to 2012. Preoperative serum 25-hydroxyvitamin D (25[OH]D) levels were measured, and the primary and secondary outcomes included foot and ankle outcome scores (FAOS) and ankle range of motion. Data were also collected on patient comorbidities, articular malreductions, and wound complications. Included patients had at least 12 months of clinical outcome data.

Results

Ninety-eight patients operatively treated for ankle fractures met our inclusion criteria. Of these 98 patients, 36 (37 %) were deficient in vitamin D (<20 ng/ml) and 31 (32 %) had vitamin D insufficiency (<30 ng/ml, ≥20 mg/ml). Patients with vitamin D deficiency were similar with regard to age, gender, and comorbidities compared to patients with vitamin D levels ≥20. Univariate analysis revealed that patients with vitamin D deficiency had significantly worse FAOS with regard to symptoms (P = 0.017) and quality of life (P = 0.040) domains than patients with vitamin D levels ≥20. Multivariate regression analysis suggested that vitamin D deficiency was a factor in inferior FAOS with regard to symptoms, activities of daily living, and quality of life.

Conclusions

In our group of patients with operative treated ankle fractures, preoperative vitamin D deficiency correlated with inferior clinical outcomes at a minimum of 1 year follow-up. Our study suggests that deficient vitamin D levels may result in worse outcomes in orthopaedic trauma patients recovering from fracture fixation.

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References

  1. Patton CM, Powell AP, Patel AA (2012) Vitamin D in orthopaedics. J Am Acad Orthop Surg 20:123–129. doi:10.5435/JAAOS-20-03-123

    Article  PubMed  Google Scholar 

  2. Holick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281. doi:10.1056/NEJMra070553

    Article  CAS  PubMed  Google Scholar 

  3. Holick MF (2006) High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc 81:353–373. doi:10.4065/81.3.353

    Article  CAS  PubMed  Google Scholar 

  4. Bee CR, Sheerin DV, Wuest TK, Fitzpatrick DC (2013) Serum vitamin D levels in orthopaedic trauma patients living in the northwestern United States. J Orthop Trauma 27:e103–e106. doi:10.1097/BOT.0b013e31825cf8fb

    Article  PubMed  Google Scholar 

  5. Bogunovic L, Kim AD, Beamer BS et al (2010) Hypovitaminosis D in patients scheduled to undergo orthopaedic surgery: a single-center analysis. J Bone Joint Surg Am 92:2300–2304. doi:10.2106/JBJS.I.01231

    Article  PubMed Central  PubMed  Google Scholar 

  6. Carpintero P, Garcia-Lazaro M, Montero M et al (2006) Relationship between 1,25-dihydroxycholecalciferol levels and functional outcome after hip fracture in elderly patients. Joint Bone Spine 73:729–732. doi:10.1016/j.jbspin.2006.01.029

    Article  CAS  PubMed  Google Scholar 

  7. Di Monaco M, Vallero F, Di Monaco R et al (2005) Serum levels of 25-Hydroxyvitamin D and functional recovery after hip fracture. Arch Phys Med Rehabil 86:64–68. doi:10.1016/j.apmr.2004.02.013

    Article  PubMed  Google Scholar 

  8. Di Monaco M, Vallero F, Di Monaco R et al (2006) 25-hydroxyvitamin D, parathyroid hormone, and functional recovery after hip fracture in elderly patients. J Bone Miner Metab 24:42–47. doi:10.1007/s00774-005-0644-1

    Article  PubMed  Google Scholar 

  9. Johnson AL, Smith JJ, Smith JM, Sanzone AG (2013) Vitamin D insufficiency in patients with acute hip fractures of all ages and both sexes in a sunny climate. J Orthop Trauma 27:e275–e280. doi:10.1097/BOT.0b013e318291f263

    Article  PubMed  Google Scholar 

  10. Lee HJ, Gong HS, Song CH et al (2013) Evaluation of vitamin D level and grip strength recovery in women with a distal radius fracture. J Hand Surg Am 38:519–525. doi:10.1016/j.jhsa.2012.12.002

    Article  PubMed  Google Scholar 

  11. Reinhardt KR, Lazaro LE, Umunna B-P et al (2013) Plasma 25-hydroxyvitamin d levels in operative patella fractures. HSS J 9:17–20. doi:10.1007/s11420-012-9324-6

    Article  PubMed Central  PubMed  Google Scholar 

  12. Rozental TD, Makhni EC, Day CS, Bouxsein ML (2008) Improving evaluation and treatment for osteoporosis following distal radial fractures: a prospective randomized intervention. J Bone Joint Surg Am 90:953–961. doi:10.2106/JBJS.G.01121

    Article  PubMed  Google Scholar 

  13. Unnanuntana A, Saleh A, Nguyen JT et al (2013) Low vitamin D status does not adversely affect short-term functional outcome after total hip arthroplasty. J Arthroplast 28(315–322):e2. doi:10.1016/j.arth.2012.04.027

    Google Scholar 

  14. Maier GS, Jakobs P, Roth KE et al (2013) Is there an epidemic vitamin D deficiency in German orthopaedic patients? Clin Orthop Relat Res 471:3029–3035. doi:10.1007/s11999-013-2996-5

    Article  PubMed Central  PubMed  Google Scholar 

  15. Lavernia CJ, Villa JM, Iacobelli DA, Rossi MD (2014) Vitamin D insufficiency in patients with THA: prevalence and effects on outcome. Clin Orthop Relat Res 472:681–686. doi:10.1007/s11999-013-3172-7

    Article  PubMed Central  PubMed  Google Scholar 

  16. Nawabi DH, Chin KF, Keen RW, Haddad FS (2010) Vitamin D deficiency in patients with osteoarthritis undergoing total hip replacement: a cause for concern? J Bone Joint Surg Br 92:496–499. doi:10.1302/0301-620X.92B3.23535

    Article  CAS  PubMed  Google Scholar 

  17. Unnanuntana A, Rebolledo BJ, Gladnick BP et al (2012) Does vitamin D status affect the attainment of in-hospital functional milestones after total hip arthroplasty? J Arthroplast 27:482–489. doi:10.1016/j.arth.2011.05.023

    Article  Google Scholar 

  18. Lauge-Hansen N (1952) Fractures of the ankle. IV. Clinical use of genetic roentgen diagnosis and genetic reduction. AMA Arch Surg 64:488–500

    Article  CAS  PubMed  Google Scholar 

  19. Little MMT, Berkes MB, Schottel PC et al (2015) Anatomic fixation of supination external rotation type IV equivalent ankle fractures. J Orthop Trauma 29:250–255. doi:10.1097/BOT.0000000000000318

    Article  PubMed  Google Scholar 

  20. Berkes MB, Little MTM, Lazaro LE et al (2013) Articular congruity is associated with short-term clinical outcomes of operatively treated SER IV ankle fractures. J Bone Joint Surg Am 95:1769–1775. doi:10.2106/JBJS.L.00949

    Article  PubMed  Google Scholar 

  21. Dawson-Hughes B, Mithal A, Bonjour J-P et al (2010) IOF position statement: vitamin D recommendations for older adults. Osteoporos Int 21:1151–1154. doi:10.1007/s00198-010-1285-3

    Article  CAS  PubMed  Google Scholar 

  22. Slomski A (2011) IOM endorses vitamin D, calcium only for bone health, dispels deficiency claims. JAMA 305(453–4):456. doi:10.1001/jama.2011.50

    Google Scholar 

  23. Roos EM, Brandsson S, Karlsson J (2001) Validation of the foot and ankle outcome score for ankle ligament reconstruction. Foot Ankle Int 22:788–794

    CAS  PubMed  Google Scholar 

  24. Roos EM, Lohmander LS (2003) The knee injury and osteoarthritis outcome score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 1:64. doi:10.1186/1477-7525-1-64

    Article  PubMed Central  PubMed  Google Scholar 

  25. De Boer IH, Levin G, Robinson-Cohen C et al (2012) Serum 25-hydroxyvitamin D concentration and risk for major clinical disease events in a community-based population of older adults: a cohort study. Ann Intern Med 156:627–634. doi:10.7326/0003-4819-156-9-201205010-00004

    Article  PubMed Central  PubMed  Google Scholar 

  26. Larsen ER, Mosekilde L, Foldspang A (2004) Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: a pragmatic population-based 3-year intervention study. J Bone Miner Res 19:370–378. doi:10.1359/JBMR.0301240

    Article  CAS  PubMed  Google Scholar 

  27. Jackson RD, LaCroix AZ, Gass M et al (2006) Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med 354:669–683. doi:10.1056/NEJMoa055218

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Orthopaedic Trauma Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Stephen J. Warner, Matthew R. Garner & Dean G. Lorich

  2. Epidemiology and Biostatistics, Hospital for Special Surgery, New York, NY, USA

    Joseph T. Nguyen

  3. Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA

    Dean G. Lorich

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  1. Stephen J. Warner
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  2. Matthew R. Garner
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  3. Joseph T. Nguyen
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  4. Dean G. Lorich
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Correspondence to Stephen J. Warner.

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Warner, S.J., Garner, M.R., Nguyen, J.T. et al. Perioperative vitamin D levels correlate with clinical outcomes after ankle fracture fixation. Arch Orthop Trauma Surg 136, 339–344 (2016). https://doi.org/10.1007/s00402-015-2376-6

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  • DOI: https://doi.org/10.1007/s00402-015-2376-6

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