Soft Tissue Outcomes of Timing for Surgical Intervention of Ankle Fractures

The purpose of our study is to offer further insight in the decision-making for surgical timing to better minimize risk of post operative soft tissue complications.

Our retrospective study evaluated 296 patients who had an ankle open reduction internal fixation (ORIF) that met our inclusion and exclusion criteria.

We attempted to exclude other factors that would influence outcomes of soft tissue complications such as comorbidities, age, open injuries or any prior surgeries to the same region. Outcomes of interest included surgical site infections (superficial and deep) as well as wound healing delay. In addition, we also evaluated complications of ankle fracture surgery based on the type of ORIF.

Our average time to surgical intervention was 4.4 days with 85 patients (28.7%) having surgery less than 2 days from injury, 144 patients (48.6%) having surgery between 2 and 6 days, and 67 patients (22.6%) having surgery 7 days or greater from injury. We found a lack of significant difference in surgical site infection rates or wound healing time between those who had an ankle ORIF less than 2 days, 2 and 6 days or 7 days or greater 7 days from injury. However, patients who had an ORIF of a trimalleolar fracture with posterior malleolar fixation had a significantly higher rate of superficial surgical site infection (13.3%) compared with those who only had a lateral malleolar ORIF (1.4%).

Based on our results, we found a lack of significant difference in soft tissue complications between our time points based on prior literature when the soft tissue envelope is stable. This knowledge can help guide scheduling decisions to avoid unnecessary hospital costs, late night ankle ORIF, and improve surgeon quality of life without compromising patient care. Further randomized controlled trials or larger samples sizes with less variance distribution are needed to validate this topic.Levels of Evidence: 3.