The influence of timing of surgery on soft tissue complications in closed ankle fractures

Abstract

Background

The timing of surgery for closed ankle fracture is controversial. Conventional teaching recommends either immediate surgery or a delay of 5–7 days in order to minimise soft tissue complications. However, there have been no large studies to produce clear guidelines and the literature is conflicting. Some authors suggest that delayed surgery results in increased risk of wound complications, less satisfactory rate of anatomical reduction, increased hospital stay and health service cost.

Objective

We aimed to determine whether surgery can be safely performed in an intermediate time frame with respect to soft tissues complications.

Method

We performed retrospective analysis of case notes and plain radiographs of 85 patients undergoing open reduction and internal fixation for closed ankle fractures at our unit in 2004. Data were analysed using the StatView statistical analysis program.

Results

The overall incidence of infection in our population of 85 patients was 9.4%. This comprised seven superficial wound infections and one deep infection. The incidence of infection in patients undergoing surgery after 6 days was significantly higher than those undergoing surgery earlier (3.6 vs 20.7%, χ² = 6.57, P = 0.010). Kaplan–Meier analysis showed a decreased cumulative probability of non-infection with increasing time.

Conclusion

We suggest that with experience, meticulous soft tissue handling and good operative technique, delaying surgery until swelling has subsided completely is unnecessary in the majority of patients and is associated with a higher risk of wound complication.