Ankle fractures: Impact of timing of surgery

Adamson, S.P.; Trickett, Ryan W; Hodgson, P.; Mohanty, Khitish

doi:10.1016/j.injury.2009.06.274

Cited by 7 publications

(2 citation statements)

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“…Pilskog and coworkers suggested that in low-energy ankle fractures with involvement of the posterior malleolus the clinical outcome is superior in patients who had surgery within the first 24 to 48 h opposed to after 7 days ( 32 ). Multiple other authors support these findings ( 13 , 33 , 34 ). However, logistical restrictions such as limited availability of surgical capacity especially in smaller hospitals on weekends or at night and a lack of experienced foot and ankle surgeons at such times, need to be taken into consideration as well ( 13 ).…”

Section: Timing Of Surgerymentioning

confidence: 55%

Treatment strategies for complex ankle fractures—current developments summarized in a narrative review

Mair,

Pflüger,

Hanschen

et al. 2023

Ann Transl Med

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Background and Objective Ankle fractures occur frequently in patients throughout all ages. Due to the many pitfalls associated with their treatment, complex ankle and especially tibial pilon fractures remain a challenge for surgeons. As there is still need for improvement in treating complex ankle fractures and treatment options are steadily increasing this review aims to summarize current practice and aims to highlight current developments by reviewing the literature. Methods We conducted a thorough search of PubMed database in December 2022 to identify relevant articles on complex ankle and tibial pilon fractures. Articles in English and German were included in this study. Key Contents and Findings Complication rates, especially wound infection are still high, emphasizing the need for careful preoperative planning. Soft tissue management is crucial to reduce complication rates and will often dictate the treatment plan utilized. Open reduction and internal fixation (ORIF) remains the treatment of choice. Nevertheless, in select cases alternative methods such as external fixation, tibiotalocalcaneal nailing or conservative treatment need to be considered as well. Furthermore, additional treatment options such as arthroscopically assisted surgery might help to improve functional outcome after complex ankle fractures. The incidence of complex ankle fractures in geriatric patients keeps rising with our aging population. This group of patients demands particular care and further high-quality studies are needed to warrant best results. Conclusions However, more randomized controlled trials are need in order to enhance evidence of newly developed treatment options.

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Section: Timing Of Surgerymentioning

confidence: 55%

Treatment strategies for complex ankle fractures—current developments summarized in a narrative review

Mair,

Pflüger,

Hanschen

et al. 2023

Ann Transl Med

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“…Previous studies have reported a higher rate of wound complications associated with delayed ORIF, although the cut-point time for a "delayed" operation ranged from 24 to 48 hours to 1 week after injury. 7,[17][18][19] Schepers et al 7 reported a higher rate of infectious wound complications in ankle fracture surgery performed later than 24 hours after injury. They recommend ORIF within the first day after injury.…”

Section: Discussionmentioning

confidence: 99%

Timing of Open Reduction and Internal Fixation of Ankle Fractures

Tantigate

Kirschenbaum

et al. 2018

Foot & Ankle Specialist

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Background. Unstable ankle fractures are treated with open reduction internal fixation (ORIF) to prevent posttraumatic arthritis. Typically, ORIF is performed as an ambulatory surgery several days to a few weeks after injury. It is unclear what effect this delay may have on functional outcome. This study aimed to assess the effect of timing of ankle ORIF on wound complications and functional outcome. Methods. A retrospective review of 121 patients who underwent ankle ORIF was performed. A total of 58 patients had a follow-up of at least 24 months. Time between injury and surgery greater than 14 days was defined as “delayed.” Demographic variables, injury characteristics, length of surgery, and postoperative stay were documented. Comparison of demographic variables, wound complications, and functional outcome determined by Foot and Ankle Outcome Score (FAOS) was performed. Results. 118 patients were included. The duration between injury and surgery was 6 days in the “early” group and 19 days in the “delayed” group. There were no significant differences in demographic variables, injury characteristics, and length of surgery between the groups. Wound complications in the early and delayed groups were 5% and 11.8%, although this difference was not statistically significant. Among 58 patients who had a follow-up of at least 24 months, the median follow-up time was 38 (range, 24-76) months. Each subscale of FAOS demonstrated no significant difference. Conclusion. Ankle ORIF more than 14 days after injury did not significantly increase the rate of wound complication, nor did it impair ultimate functional outcome in this group. Levels of Evidence: Level III

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The timing of ankle fracture surgery and the effect on infectious complications; A case series and systematic review of the literature

Schepers

Vries

Lieshout

et al. 2013

International Orthopaedics (SICOT)

137

105

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Purpose Information about the influence of delayed surgery on infectious wound complications is ambiguous. A clinical audit was performed to test the hypothesis that early surgery lowers the rate of infectious wound complications. Secondly we looked at the influence of surgical delay and complications on patient reported functional outcome. Methods All consecutive, closed distal fibular fractures treated surgically with a plate were included and retrospectively analysed for the delay in operation and wound complications. In a second cohort of patients with a AO-Weber Btype ankle fracture outcome was measured using the OlerudMolander ankle score (OMAS), the American Orthopaedic Foot and Ankle Society score (AOFAS) and a visual analog score (VAS) for overall satisfaction. Results Patients treated within one day experienced no wound complications (zero out of 60), whereas in the delayed group 11 % (16/145) did (p=0.004). A similar significant difference was found for the patients treated within one week (2/98) versus after one week (14/107). A systematic review of the literature showed a difference in wound complications of 3.6 % (early) versus 12.9 % (late) (p<0.0001). After 43 months, the median AOFAS was 11.5 points lower in the complication group, the OMAS 10 points, and the VAS 0.5 points, with all differences being statistically significant. Conclusions Every effort should be made to operate on closed ankle fractures as soon as reasonably possible. A delay in surgery is associated with a significant rise in infectious wound complications, which significantly lowers outcome and patient satisfaction. These fractures should preferably be treated within the first day.

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Ankle fractures: Impact of timing of surgery

Cited by 7 publications

References 0 publications

Treatment strategies for complex ankle fractures—current developments summarized in a narrative review

Treatment strategies for complex ankle fractures—current developments summarized in a narrative review

Timing of Open Reduction and Internal Fixation of Ankle Fractures

The timing of ankle fracture surgery and the effect on infectious complications; A case series and systematic review of the literature

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