Swollen Ankle Fractures: What Predicts Delays in Definitive Fixation?

Delaying definitive fixation of ankle fractures helps reduce soft tissue complications, and estimating the timing to definitive fixation can aid in optimizing treatment plans. The purpose of this study was to compare pilon and malleolar fractures in terms of time to definitive treatment and to evaluate the correlation between timing and radiographic parameters measured on computed tomography (CT).

In this single-center retrospective observational study, adult patients with pilon or malleolar fractures treated with two-stage surgery for soft tissue swelling between 2022 and 2024 were analyzed. Fracture type (malleolar or pilon) was assessed using X-rays and CT. Syndesmotic distance, anterior distance, medial and lateral soft tissue distance, and bone/soft tissue ratio were measured on axial CT scans. The relationship between time to definitive surgery, fracture type, and CT measurements was analyzed. Soft tissue complications were recorded.

Of 88 patients enrolled, 57 (64.8%) had malleolar fractures and 31 (35.2%) had pilon fractures. The median time to definitive fixation was 8 days [6-10] overall (7 days [6-10] for malleolar fractures vs. 8 days [6-11] for pilon fractures; p=0.336). Timing showed a negative correlation with anterior distance (p=0.003) and a positive correlation with bone/soft tissue ratio (p=0.041). Four patients developed wound complications; none required hardware removal.

In staged surgical treatment, the median time to swelling resolution was 8 days, similar for both fracture types. Longer times were associated with reduced soft tissue coverage, correlating negatively with anterior distance and positively with the bone/soft tissue ratio.