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Pre-operative Edema Reduction - Ankle Fracture

Accelerating readiness for theatre in patients requiring Open Reduction
Internal Fixation (ORIF)

Management of pre-operative Edema

Ankle swelling can often delay surgical fixation due to risk associated with operating on swollen tissue, including wound dehiscence and subsequent infection1.

Interventions that reduce swelling and accelerate readiness to theatre for more immediate surgical fixation can provide significant benefits to patients and healthcare providers1.


Current care might typically include leg elevation plus:

  • Backslab plaster cast.
  • Backslab plaster cast + external fixation.
  • Backslab plaster cast + intermittent pneumatic compression (IPC).


The geko™ device is proven to
accelerate readiness for theatre

A prospective and retrospective study, conducted by a major NHS trauma centre, investigated use of the geko™ to reduce pre-operative edema in ankle fracture patient requiring Open Reduction Surgical Fixation (ORIF), and compared the results to current standards of care.

The geko™ device was fitted above the backslab plaster. The study measured patient compliance and readiness to theatre, matched to the historical cohort.

The study data was statistically significant in accelerating readiness for theatre: p=0.0012.


Results show:   

  • 2 days improvement in readiness to theatre per patient (average)
  • With geko™ use, 60% of patients ready for theatre in 2 days, compared to 27% in control arm, a 122% improvement.
  • Current treatment = 3.66 days readiness to theatre (average).
  • The geko™ + plaster cast = 1.66 days readiness to theatre (average).
  • The geko™ was well tolerated and easy to use.

The geko™ device is cost saving

Independent health economic analysis, of the study outcome, shows routine use the geko™ device + backslab plaster cast, to accelerate readiness to theatre, saves an average of £5693 per patient, compared to current standards of care.

Associated clinical benefits

Successful edema management promotes:

  • Post-operative wound closure and surgical site infection reduction2,4.
  • Accelerated recovery – rehabilitation can begin sooner4.
  • Improved theatre time scheduling5.

Associated geko™ benefits

NICE guidance (MTG19) recommends use of geko™ to:

  • Reduces the risk of DVT in patients who may be contraindicated to drugs or mechanical prophylaxis6.

The geko™ is clinically proven to increase blood flow velocity in the deep veins, and in patients with plaster casts:

  • Griffin & Nicolaides report that the geko™ significantly increases blood flow velocity in the deep Veins of the calf (p=0.001-0.05), where early thrombi form7.
  • Warwick et al report that geko™ significantly increases blood flow velocity in patients with plaster casts (p=0.001-0.003), where calf muscle activation is reduced8.

References:

  1. Keehan R, Guo S, Ahmad R, Bould M. Impact of intermittent pneumatic foot pumps on delay to surgery following ankle fracture. Foot Ankle Surg 2013 Sep;19(3):173-176.
  2. James Cook, retrospective data on file, April 2017, Firstkind.
  3. Health economic analysis performed subsequent to the completion of the study by Mtech Access Ltd, Bicester UK, 2017.
  4. Caschman J, Blagg S, Bishay M. The efficacy of the A-V Impulse system in the treatment of posttraumatic swelling following ankle fracture: a prospective randomized controlled study. J Orthop Trauma 2004 Oct;18(9):596-601.
  5. NHS Modernisation Agency. Theatre Programme. Step Guide to Improving Operating Theatre Performance. June 2002.
  6. NICE medical technologies guidance (MTG19). Published date: June 20 2014.
  7. A.Nicolaides, M Griffin, Measurement of blood flow in the deep veins of the lower limb using the geko™ neuromuscular electro-stimulation device. Journal of International Angiology August 2016-04.
  8. Warwick D, et al. Neuromuscular electrostimulation via the common peroneal nerve promotes lower limb blood flow in a below-kneecast: A potential for thromboprophylaxis. Bone Joint Res 2013; 2:179–85.
  9. Wainwright TW, Immins T, Middleton RG, Poster Physiotherapy UK, October 2014, Birmingham.
  10. Klabunde, RE (2014). Cardiovascular Physiology Concepts. Available at: http://cvphysiology.com/Microcirculation/M010 [Accessed 21 Feb. 2018].

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