Time to Surgery Affects Wound Healing of Ankle Fractures

Abstract

Category: Trauma; Ankle Introduction/Purpose: Ankle fractures are very common. Most unstable ankle fractures require surgical intervention in order to obtain better clinical outcomes. However, there is still conflicting evidence about the implications of time to surgery on post- operative wound complications. Purpose of study: To investigate if early or delayed surgery results in difference in wound complications in patients who underwent surgical intervention for ankle fracture. Methods: A retrospective review of 238 ankle fracture cases treated with open reduction and internal fixation (ORIF) from October 28, 2016, through May 12, 2022 was completed at our institution. Patients were divided into 4 groups based on the time to surgery. In group 1, surgery was within a week. In group 2, surgery was in 2nd week. In group 3, surgery was in 3rd week. In group 4, surgery was after 3 weeks. Wound complications including minor wound complication and wound infection were investigated. The other factors including BMI, smoking, diabetes, etc. were investigated as well to avoid confounding bias. Since most of patients accepted surgery either in first 4 days (early surgery group) or between 10 to 20 days (delayed surgery group) in this series of patients. We also analyzed those two time points. Data was analyzed using STATA. Results: 238 patients with ankle fracture were analyzed. 36, 96, 71 and 35 patients were included in group 1, 2, 3 and 4 respectively. For BMI, smoking, and diabetes, no significant difference among 4 groups. The rate of minor wound complications in group 1, 2, 3 and 4 was 13.8%, 12.5%, 8.5% and 0%. The rate of wound infection in group 1, 2, 3 and 4 was 5.6%, 3.1%, 1.4% and 0%. For minor wound complication, there was significant decrease in group 4, as compared with group 1 and group 2 (p < 0.05). Interestingly, in term of early vs delayed surgery, both infection rate (13.3% vs 2.8%) and minor wound complication rate (33.3% vs 10.8%) significantly decreased in the delayed surgery group (p < 0.05). Conclusion: Delayed ORIF of ankle fracture resulted in decreased both minor wound complication rate and infection rate.