Safety and Outcomes of Early Fixation in Patients who Suffered an Ankle Fracture

Abstract

Category: Ankle Introduction/Purpose: Ankle fractures are a common injury in the United States leading to increased ER visits and healthcare costs. Additionally, these injuries normally lead to prolonged immobilization that can make it difficult for patients to return to work and normal activities. By optimizing fracture healing and decreasing the amount of time to union patients can avoid the frustration of prolonged immobilization and return to daily activities more quickly. It is believed that early surgical fixation of ankle fractures can lead to wound complications while late fixation can lead to issues with reduction during surgical intervention. This study was undertaken to determine if there is a difference in wound complication and time to union between early and late fracture fixation. Methods: From July of 2008 to June of 2018, a retrospective chart review of 321 patients who underwent ankle fracture corrected with ORIF was performed at a single institution. Patients with pilon fractures, poly trauma, open fractures, or less than 3 months of follow up time were excluded from our study. After exclusion were made there was 232 patients remaining. All patients were then stratified by time to surgery after injury and injury classification. The cohorts were surgery within 2 days with 31 patients, surgery within 7 days with 69 patients, and patients that had surgery after 8 days (132). The patients were also stratified according to the Lauge-Hansen classification. The cohorts were PA, PER, SA, and SER. Results: The average time to union for patients who were operated on within 2 days of injury was 108.48 days, 106.52 days for patients operated on between 3-7 days, and 97.59 days for patients operated on after 7 days. Wound complications were highest in the cohort operated on within 2 days at 9.6%. Patients operated on between 3 and 7 days had the lowest rate of wound complications at 2.8%/. Patients with an SER Lauge-Hansen classification has the fastest time to union at 94.04 days and individuals with an SA had the longest at 139.30 days. Wound frequency for patients with a classification of PA had the highest wound complications at 20%. Conclusion: There has been little research done on how time to surgery affects wound complications and healing time in ankle fracture fixation. Patients that received surgery after 7 days achieved union the fastest. We saw that wound complication rate was greatest in the cohort that had surgery within 2 days of injury. Injury classification did factor into union time and wound complications. Overall, there was not a significant difference in wound complication between early fixation and delayed fixation.