Delayed Surgery for Ankle Fractures is Associated with Poor Patient Reported Outcome

Abstract

Category: Trauma; Ankle Introduction/Purpose: Several studies discuss the relation between prolonged time to surgery and postoperative complications in ankle fractures, but little is known about how a longer wait affects clinical outcomes. The present study, therefore, aims to assess the association between time from injury to surgery and patient-reported outcomes after operative treatment of severe ankle fractures. Methods: Patients treated operatively for low-energy ankle fractures which also involve the posterior malleolus from 2014 to 2016 were included. Patient charts were reviewed for patient demographics, type of trauma, fracture characteristics, treatment given, and complications. Ankle function was evaluated on a follow-up visit by clinical examination, radiographs and patient- reported outcome measures (SEFAS, RAND-36, VAS of Pain, VAS of Satisfaction). For analyses, patients were stratified based on time from injury to definitive surgery; Group 1: within the same day, Group 2: 1 to 7 days after injury, and Group 3: later than 7 days after injury. Results: Follow-up visits of 130 patients were performed at median 25 (Interquartile range (IQR), 19-34) months after surgery. Patient demographics and fracture characteristics were similar between groups. Median SEFAS was 40 in Group 1 (IQR 33-43), 41 (IQR 33-44) in Group 2, and 33 (IQR 27-42) in Group 3. The difference between Group 1 and 3 (p =.03), and between Group 2 and 3 (p =.04) was statistically significant. Group 1 had the highest rate of mechanical irritation and secondary surgery following malreduced fractures or missing syndesmotic fixation. Patients operated later than seven days from injury reported more pain than those treated earlier (p =.03). Conclusion: Time from injury to final surgery influenced clinical outcomes after these severe ankle fractures. Patients who waited more than seven days until definitive surgery had poorer clinical outcomes and more pain compared to those who had surgery within a week.