Does T wave flattening in a healthy 33-year-old patient with a bimalleolar ankle fracture warrant a cardiology consultation for preoperative (pre-op) clearance?

From the Guidelines

T wave flattening alone in a healthy 33-year-old patient undergoing surgery for a bimalleolar ankle fracture does not warrant cardiology consultation for preoperative clearance. This recommendation is based on the 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery, which states that routine preoperative resting 12-lead ECG is not useful for asymptomatic patients undergoing low-risk surgical procedures 1. The guideline suggests that the value of the preoperative 12-lead ECG increases with the risk of the surgical procedure, particularly for patients with known coronary heart disease, arrhythmias, peripheral arterial disease, cerebrovascular disease, or other significant structural heart disease.

Some key points to consider in this scenario include:

• The patient's age and lack of cardiac symptoms or risk factors, which suggest a low risk of cardiac complications during surgery
• The type of surgery, which is considered low-risk for cardiac complications
• The ECG finding of T wave flattening, which is often a non-specific change that can occur due to various benign factors
• The importance of focusing on the patient's overall health status, including vital signs, physical examination, basic laboratory tests, and any symptoms suggestive of cardiac disease

In the absence of other concerning ECG findings, cardiac symptoms, poor functional status, or multiple cardiovascular risk factors, proceeding with surgery without cardiology consultation is reasonable. However, if any of these factors are present, then cardiology consultation would be appropriate before proceeding with surgery 1.

From the Research

T Wave Flattening in a Healthy 33-Year-Old Undergoing Surgery for Bimalleolar Ankle Fracture

• The provided studies do not directly address the issue of T wave flattening in a healthy 33-year-old undergoing surgery for bimalleolar ankle fracture.
• However, the studies focus on the treatment and rehabilitation of bimalleolar ankle fractures, with no mention of cardiac complications or the need for cardiology consultation for preoperative clearance in healthy individuals 2, 3, 4, 5, 6.
• None of the studies provide evidence on the relationship between T wave flattening and the need for cardiology consultation in the context of bimalleolar ankle fracture surgery.
• It can be inferred that the decision to consult cardiology for preoperative clearance would depend on individual patient factors, such as underlying medical conditions or abnormal electrocardiogram (ECG) findings, rather than the type of surgery being performed 2, 3, 4, 5, 6.

Relevant Factors in Bimalleolar Ankle Fracture Treatment

• The timing of surgery and type of reconstruction are important factors in achieving good radiological outcomes in bimalleolar ankle fractures 3.
• Deltoid ligament repair may be a favorable treatment strategy in unstable distal fibula fractures, with similar functional scores and fewer reoperations compared to trans-syndesmotic fixation 4.
• Bimalleolar and trimalleolar fractures, associated presence of dislocation, and osteochondral lesions are associated with worse clinical outcomes and lower return to sporting activity 5.
• Early commencement of weight-bearing and the use of a removable type of immobilization to allow exercise during the immobilization period after surgical fixation may be beneficial in rehabilitation 6.