The Impact of Surgical Timing After Ankle Fracture on Clinical and Long-Term Patient Reported Outcomes

Abstract

Category: Trauma; Ankle Introduction/Purpose: The goal of this study is to evaluate the effect of time-to-surgery following closed ankle fractures on long- term patient reported outcomes, fracture healing, and wound complications. To date, little research has been done focusing on the impact “time to definitive fixation” has on patient reported outcomes. Methods: We performed a retrospective analysis of 215 patient records who underwent open reduction and internal fixation (ORIF) for an ankle fracture from July 2011 to July 2018. A total of 86 patients completed the patient reported outcome measurement information systems (PROMIS) survey at long term follow up. Primary outcomes were the rate of delayed union, postoperative wound complications, Patient Reported Outcome Measurement Information System (PROMIS) Pain Interference (PI), and Physical Function (PF) scores. Results: No differences were found when comparing time to surgery on a continuous scale with rates of delayed union, nonunion, or wound complications (p=0.84, 0.47, and 0.63, respectively). PROMIS scores were collected at a median of 4.5 years (2.0 interquartile range (IQR), Range 2.5 to 12.3) postoperatively. The time from ankle fracture to surgery was independently associated with worse PROMIS PI scores (Unstandardized β .38, 95% CI 0.07 to 0.68) but not PROMIS PF scores. Severe Lauge- Hansen injuries were independently associated with decreased PROMIS PF scores (Unstandardized β -7.02, 95% CI -12.0 to -2.04). Increased time to surgical intervention and severe Lauge Hansen injuries were independently associated with worse long-term patient reported outcomes. Surgical timing did not impact union rates or wound complications. Conclusion: Surgeons should be aware that delaying ankle fracture repair beyond 12 days after injury may negatively affect long- term patient reported pain scores.