Early versus delayed treatment of severe ankle fractures: a comparison of results

A retrospective review of 202 closed Weber B bimalleolar or bimalleolar equivalent ankle fractures treated using open reduction and internal fixation (ORIF) from January 1, 1991, through January 1, 1994 was completed at our institution. A total of 105 ankles (52%) were treated using ORIF within 5 days of injury (early group), with a mean 1.5 days from injury to surgery. A total of 97 ankles (48%) were treated after 5 days (delayed group), with a mean of 13.6 days from injury to surgery. Operative time, length of hospital stay, postoperative range of motion, adequacy of reduction, wound and other complications, and other sequelae were compared between the two groups. No significant difference in range of motion at latest follow-up or in operative time was evident between the groups. Minor wound complications were present in 4.8% of the early group compared with 6.2% in the delayed group. No deep infections or osteomyelitis were present in either group. Anatomic reductions were present in 89% and poor reductions (> 2 mm displacement) in 1% of those ankles treated within 5 days versus 83% anatomic reductions and 3% poor reductions in those treated after 5 days. The differences in wound complications and anatomic reductions between groups was not statistically significant. There was a significantly longer median hospital stay in the early (3 days) versus delayed groups (2 days). We conclude that the results and complications of early versus delayed treatment is not significantly different, except for a shorter median hospital stay in the delayed group. Delayed ORIF is an acceptable alternative when soft-tissue swelling, fracture blisters, or abrasions are present that offer an undesirable environment for surgical incisions. Using contemporary, a traumatic techniques, delayed surgery can provide anatomic reduction with minimal complications in severe ankle fractures.