Impact of intermittent pneumatic foot pumps on delay to surgery following ankle fracture

Abstract

Ankle fractures requiring open reduction and internal fixation (ORIF) are common and place considerable burden on inpatient beds. ORIF cannot be performed once the associated swelling is too excessive to permit tension-free wound closure. Where ORIF cannot be performed before the onset of swelling in the first 24-48h, patients typically require up to 7 days of inpatient bed-rest and elevation to reduce swelling to an acceptable level for ORIF. The primary aim of this study was to determine whether delay to ORIF could be reduced with the pre-operative application of an intermittent pneumatic foot pump (IPF). These devices were designed as anti-embolic adjuncts, but have also been shown to be effective in the reduction of swelling. We compared 12 patients managed with an IPF to 12 matched historical controls who were not. No previous studies have addressed this question in unselected patients requiring ankle ORIF. We performed a retrospective, controlled, before and after study of 24 patients who underwent ankle ORIF at our orthopaedic unit. Foot pumps were applied in the Accident and Emergency Department to ankle fracture patients requiring admission, and kept in place until ORIF. Data was collected from patient case notes for all patients. Patients were matched for age, gender, American Society of Anaesthesiologists (ASA) Grade, and pre-injury mobility. The primary outcome measure was time to surgery. We also recorded total hospital stay, and calculated cost savings. Patients managed with IPFs had a statistically significant 50% reduction in time from presentation to surgery compared to those managed without (p=0.024), and had a reduced hospital stay (p=0.116). This resulted in a net saving of £10,480 (£953 per patient). We conclude that foot pumps reduce the time to surgery and total hospital stay of patients requiring ankle ORIF, and are cost effective.