Abstract:
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Posterior malleolus fractures are fractures of the posterior tibia at the ankle. Historical variation exists regarding when to surgically treat posterior malleolus fractures based on the size of the posterior articular surface involved. We studied the effect of surgically treating posterior malleolus fractures on one-year post-operation PROMIS (the Patient-Reported Outcomes Measurement Information System) using an observational cohort of 93 patients at the Hospital for Special Surgery. The effect of surgical treatment, under two different dynamic treatment regimes (all patients with >15% articular surface involved receive surgery and all patients with >25% of articular surface involved receive surgery), on physical function, pain interference, and pain intensity was evaluated using Cross-Validated Targeted Maximum Likelihood Estimation (CV-TMLE) with the lmtp R package. After adjusting for baseline confounders, no evidence was found of a differential effect of surgical treatment rules on self-reported physical function, pain intensity, or pain interference at one-year post-operation.
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