Early versus Late Surgery for Closed Ankle Fractures

Singh, Rohit; Trickett, Ryan W; Hodgson, P.

doi:10.1177/230949901502300317

Cited by 26 publications

(25 citation statements)

References 21 publications

(18 reference statements)

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“…It has recently been reported that patients who have surgery for closed ankle fractures within 24 hours of injury have shorter length of stay than those operated on later [16]. Our data do not confirm this.…”

Section: Discussioncontrasting

confidence: 99%

“…The mean overall length of stay in our study of 1.72 days was considerably shorter than the mean of 4.38 days in the preliminary data that we had collected, and shorter than the mean 3.50 and 4.50 days of postoperative stay reported, respectively, by Lloyd et al [15] and Singh et al [16]. Consequently, the targeted reduction in length of stay of 1.5 days appeared to be unrealistic.…”

Section: Discussioncontrasting

confidence: 73%

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Effect on Hospital Length of Stay of Tourniquet Use During Internal Fixation of Ankle Fractures: Randomized Controlled Trial

Sim

Grocott

Majeed

et al. 2019

The Journal of Foot and Ankle Surgery

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Approximately 50% of ankle fractures require internal fixation. A tourniquet is often employed to create a bloodless operative field, but its effect on hospital length of stay (LOS) is unclear. This paper reports a parallel-group observer-blinded randomized trial of the effect of tourniquet use on LOS. 188 adult patients requiring internal fixation of ankle fracture were randomized to surgery with or without tourniquet. LOS was analyzed on intention-to-treat principles using Poisson regression. As a secondary outcome, duration of operation was analyzed by ANCOVA. Mean LOS was 1.79 ±1.50 days in the tourniquet group and 1.65 ±1.11 days in the no-tourniquet group. The covariate-adjusted rate ratio for LOS (reference group: no tourniquet) was 1.084 (95% CI 0.871, 1.348; p = .470). Sensitivity analyses (unadjusted intention-to-treat analysis and as-treated analysis) gave similar non-significant results. The covariate-adjusted mean difference in duration of operation was 3.03 minutes (95% CI -4.96, 11.02; p = .455), favoring the tourniquet group; sensitivity analyses again gave similar results. Adverse events did not differ significantly between groups. In conclusion, the use of a tourniquet during internal fixation does not significantly influence hospital LOS, of which pre-injury medical condition of the patient appears to be the most important determinant. Level of clinical evidence: 1

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 73%

Effect on Hospital Length of Stay of Tourniquet Use During Internal Fixation of Ankle Fractures: Randomized Controlled Trial

Sim

Grocott

Majeed

et al. 2019

The Journal of Foot and Ankle Surgery

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“…Likewise, if ankle fractures were delayed more than 48 h, the length of stay in hospital and the cost increased significantly. Ankle fractures in individuals over 70 years of age have been shown a high rate of complications, such as infection and delayed wound healing, and they therefore need to be prioritised [ 52 ]. Pettersson et al [ 41 ] demonstrated that 20% of hip-fracture patients suffered a serious adverse event during their hospital stay and the risk of complications occurring increased linearly over time.…”

Section: Discussionmentioning

confidence: 99%

Incidence and root causes of delays in emergency orthopaedic procedures: a single-centre experience of 36,017 consecutive cases over seven years

2018

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BackgroundEmergency surgery is unplanned by definition and patients are scheduled for surgery with minimal preparation. Some patients who have sustained emergency orthopaedic trauma or other conditions must be operated on immediately or within a few hours, while others can wait until the hospital’s resources permit and/or the patients’ health status has been optimised as needed. This may affect the prioritisation procedures for both emergency and elective surgery and might result in waiting lists, not only for planned procedures but also for emergencies.MethodThe main purpose of this retrospective, observational, single-centre study was to evaluate and describe for the number and reasons of delays, as well as waiting times in emergency orthopaedic surgery using data derived from the hospital’s records and registers. All the emergency patients scheduled for emergency surgery whose procedures were rescheduled and delayed between 1 January 2007 and 31 December 2013 were studied.ResultWe found that 24% (8474) of the 36,017 patients scheduled for emergency surgeries were delayed and rescheduled at least once, some several times. Eighty per cent of these delays were due to organisational causes. Twenty-one per cent of all the delayed patients had surgery within 24 h, whilst 41% waited for more than 24 h, up to 3 days.ConclusionA large number of the clinic’s emergency orthopaedic procedures were rescheduled and delayed and the majority of the delays were related to organisational reasons. The results can be interpreted in two ways; first, organisational reasons are avoidable and the potential for improvement is great and, secondly and most importantly, the delays might negatively affect patient outcomes.

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“…3 To prevent adverse side effects, urgent surgery is recommended in most cases of ankle fracture. Previous studies have reported higher rates of infection and longer hospital stays with delayed surgery compared with early surgery [4][5][6] .…”

Section: Introductionmentioning

confidence: 93%

Which Factors Affect Ankle Joint Swelling in Ankle Fracture Patients? - Radiological Measurement Method

Lee¹,

Ha²,

Jung³

et al. 2020

Preprint

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Background: Ankle joint swelling (AJS) in fracture patients is important for predicting soft tissue complications and deciding urgent surgery. Most surgeons still predict the progression of AJS based on their extensive experience. This study was conducted to identify factors that may affect the progression of AJS.Methods: The clinical data and radiographic images of 120 patients who have undergone surgical treatment for ankle fracture were obtained. The immediate radiographs after surgery were representative of the swelling of the ankle joint, and the radiographs 2 weeks after device removal were representative of the normal ankle joint. We defined AJS as the sum of the ankle joint skin contour diameters in the anteroposterior and lateral views. We performed multivariate regression analysis to compare the correlation between variables and AJS.Results: A total of 90 patients were included and followed up for an average of 18.1 months (range, 14–20). Three significant factors (preoperative serum glucose level, injury mechanism, and duration of surgery) were identified to affect AJS.Conclusion: Elevated preoperative serum glucose level, high-energy injury, and extended duration of surgery were more likely to aggravate AJS. These findings will help surgeons to predict the prognosis of patients with AJS and to provide proper management for patients with an ankle fracture.Level of Evidence: Retrospective cohort study, III

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Early versus Late Surgery for Closed Ankle Fractures

Abstract: Patients with delayed surgery for ankle fracture had a longer postoperative length of hospital stay. Surgery should be performed within 24 hours of injury to minimise the length of hospital stay.

Cited by 26 publications

References 21 publications

Effect on Hospital Length of Stay of Tourniquet Use During Internal Fixation of Ankle Fractures: Randomized Controlled Trial

Effect on Hospital Length of Stay of Tourniquet Use During Internal Fixation of Ankle Fractures: Randomized Controlled Trial

Incidence and root causes of delays in emergency orthopaedic procedures: a single-centre experience of 36,017 consecutive cases over seven years

Which Factors Affect Ankle Joint Swelling in Ankle Fracture Patients? - Radiological Measurement Method

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