Timing of Open Reduction and Internal Fixation of Ankle Fractures

Abstract

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

Timing of Olecranon Fracture Fixation Does Not Affect Early Complication or Reoperation Rates

“…Prior studies assessing the effects of timing on fracture fixation on outcome have used cutoffs including 24 hours, 1–2 weeks, and 5 weeks to discriminate between early versus delayed fixation. 17 , 18 , 19 , 20 However, these studies are limited, and only one study to date has defined delayed fixation for upper extremity fracture as 14 days. 20 This study defined delayed fixation similarly as greater than 14 days from injury, early fixation was defined as fracture fixation within 3 days of injury, and standard fixation was defined as fixation between 3 and 14 days from time of injury.…”

“…These results are similar to other studies that have shown no differences in outcomes after ankle fractures with regards to early versus delayed fixation. 17 , 18 Additionally, a recent systematic review assessing the effect of time-to-surgery on distal radius fracture outcomes found significantly inferior Disabilities of the Arm, Shoulder, and Hand scores among patients who underwent surgery 14 days after injury, but there were no differences in complication or revision rates. 20 The current study also found a significant association between everyday smoking and total complications.…”

“…For example, while the timing of ankle fracture fixation does not seem to influence wound or fracture healing, delayed fixation of clavicle, and distal radius fractures has been shown to have higher complication rates. 17 , 18 , 19 , 20 …”

Establishing regions of interest of the lower leg and ankle for perioperative volumetric assessment with a portable 3D scanner in orthopedic and trauma surgery – a pilot study

“…Clinical soft tissue characterization when managing severely injured limbs remains challenging and has a large subjective component based on anecdotal experience of the treating surgeon, which may lead to variable treatment algorithms that lack consensus opinion [ 18 , 19 ]. Inaccurate assessment may affect the timing of surgery and is highly correlated with soft tissue complications and longer hospitalization [ 2 ].…”

Three-dimensional gait analysis of orthopaedic common foot and ankle joint diseases

“…Fractures caused by low-energy indirect trauma are generally treated conservatively, but when conservative treatment fails to restore joint consistency and fractures are caused by high-violent trauma, surgical reduction is the preferred treatment method ( Goost et al, 2014 ). The most commonly used surgical treatment is open reduction and internal fixation (ORIF), the main purpose of which is to prevent posttraumatic arthritis and shorten the immobilization time ( Tantigate et al, 2019 ). The severity of the injury, surgical intervention and fixation time all contribute to biomechanical changes ( Egol et al, 2006 ), and recovery of these parameters after ankle treatment is critical.…”