THE INFLUENCE OF THE TIMING OF SURGERY ON THE CLINICAL OUTCOME IN SURGICALLY TREATED ANKLE FRACTURES

Abstract

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 the 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 significantly affects the outcome or wound complications following internal fixation of displaced ankle fractures.

METHOD: We retrospectively analysed the medical records of 37 patients with ankle fractures, who were admitted to the orthopaedic department at our Hospital between May 2003 and May 2004. The fractures were classified according to Dennis-Weber classification. Open reduction and rigid internal fixation was performed according to the techniques of the Association for the Study of Internal Fixation (AO Group).

RESULTS: The mean age of the patients was 41.6 years (range 19-70). According to Denis-Weber classification 2 (6%) were type A, 26 (70%) were type B and 9 (24%) were type C fractures. The mean delay before surgery was 2.4 (0-9) days. The mean length of hospital stay was 4.6 (1-13) days. 35% of the fractures were operated between the second and fourth days after the injury without any increase in wound or fracture related complications. There were no cases of wound infection or dehiscence. Although there was one case of delayed union of medial malleolus, the overall union rate was 100%.

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 5-8 days is not necessary.