Time to surgery for ankle fractures

Abstract

Category: Trauma Introduction/Purpose: Ankle fractures constitute 9% of all fractures and surgical fixation is often required when they are unstable. The bony anatomy has little soft tissue coverage overlying the malleoli. The surgical site is therefore at risk of infection and wound breakdown. BOAST guidelines advise operative fixation on the first or second day after injury. Often in practice this window is missed and fixation is undertaken many days after the injury. We aimed to prospectively review the incidence of early wound complications and infection in 300 patients treated early or late with plate osteosynthesis for Weber B or C ankle fractures. This was conducted at a UK Trauma Unit. Methods: Between November 2013 and November 2016 consecutive patients with closed, isolated ankle fractures were included. Consent was obtained for entry into the study pre-operatively and they were followed up at 2 weeks post operation. Patients were categorised by time to surgery into the following subsets: < 24 hours, < 48 hours and > 48 hours. The 2 week consultation letters were reviewed retrospectively and reported wound complications recorded. The hospital microbiology database was used to identify any positive superficial or deep wound culture results. Comorbidity data and demographics were collected. Results: 208 out of 300 patients had a complete dataset. The mean age was 46 (range 16-95). The superficial infection rate at < 24 hours, < 48 hours and > 48 hours was 4%, 0% and 3% respectively. There were no suspected deep infections at 2 weeks. There were 7 (3%) positive deep wound cultures. The mean BMI was 28 and venous thromboembolism prophylaxis was instituted for all patients as per local guidelines. 3% had diabetes and 23% were smokers. Conclusion: This study has shown that timing of surgery has not shown any significant influence on early infection rates. Surgery may be safely delayed until soft tissue swelling has reduced. However, there may be other benefits of early surgery such as reduced venous thromboembolism and improved patient reported outcome measures.