Influence of Timing of Surgery on the Clinical Outcome in Surgically Treated Ankle Fractures.

Bone and Joint Journal. Orthopaedic Proceedings May 2009, 91-B (SUPP II) 366

Ahmed 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 fractures.

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.

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