Influence of Timing of Surgery on the Clinical Outcome
in Surgically Treated Ankle Fractures.
and Joint Journal. Orthopaedic Proceedings May 2009, 91-B (SUPP
A, Ahamed AZ, Zadeh HG, Nathan S
West Middlesex University Hospital, Isleworth, Middlesex, UK.
Introduction: Ankle fractures are one of the
most common injuries treated by the orthopaedic surgeon. The
general recommendation is if surgical treatment is not carried
out within the first 24 hours from injury, then it should be
delayed for about 5–7 days to reduce the risk of wound
complications associated with limb swelling. The aim of our
study was to see whether timing of surgery affects the relative
risk of skin complications following internal fixation of ankle
Method: We analysed medical records of 102
patients with closed ankle fractures admitted to the orthopaedic
department at our hospital between May 2003 and May 2005. The
fractures were classified according to the Weber-AO classification.
Open reduction and internal fixation was performed according
to the techniques of the AO Group.
Results: The mean age of patients was 43 years(range
13–87). According to the AO classification, 3 were type
A(A1–3), 77 were type B(B1-16, B2-42, B3-16), 17 were
type C(C1-2, C2-11, C3-4), 4 were isolated medial malleolus
and 1 was Salter-Harris type 2 fractures. The mean delay before
surgery was 3(0–18) days. The mean length of hospital
stay was 6(1–44) days. Out of 102 patients, 53 of the
patients were operated within 24 hours, 22 were operated from
24–72 hours, 15 within 4 to 7 days and the rest were operated
within 7–18 days. The main reasons for delay were either
failed initial conservative management or late presentation.
There was one case of superficial wound infection, deep vein
thrombosis, neuroma and delayed union of medial malleolus each.
Conclusion: We conclude that for ankle fractures
that are not operated on within the initial 24 hours from the
injury, delayed treatment could be instituted as soon as patient
and limb factors permit and rigid adherence to waiting times
of 5–7 days is not necessary.