Title : Does delayed surgical intervention for ankle fractures affect patient outcomes
Abstract:
Introduction: Ankle fractures are common injuries that are managed by the trauma and orthopaedic surgeons. Although ankle fractures are commonly sustained by low energy mechanisms, they can also occur due to a high mechanism of injury such as road traffic collisions. The stable ankle fractures are managed conservatively, however, unstable ankle fractures often require Open Reduction and Internal Fixation (ORIF) to restore the ankle mortise and reduce the risk of long-term complications. The timing of surgery, for unstable ankle fractures, can potentially have an impact on patient outcomes. The BOAST guidelines are helpful in the management of ankle fractures, and they recommend doing the surgery within day 1 of the injury.
Objectives: The primary outcome of this study was to assess whether delay in ankle fracture surgery has an impact on patient outcomes, particularly if there are any wound complications. This study also assessed whether delayed surgery for ankle fractures has an impact on fracture union in addition to observing whether diabetes has an impact on patient outcomes.
Methods: This retrospective cohort study reviewed the ankle fractures, that were managed with ORIF at Musgrove Park hospital, from May 2022 to July 2024. The electronic database (EPRO) was used to identity the ankle fractures and the data was collected on an NHS computer using Microsoft Excel. The patients were allocated to early fixation group if they had surgery within one day of the injury and they were allocated to the delayed fixation group if they had surgery after day one of the injury.
Results: Overall, 96 patients with an ankle fracture were reviewed. There were only four patients (4.2%) who were in the early fixation group and had surgery within one day of the injury. Out of the 92 patients (95.8%) who had ORIF after day one of the injury, nine patients (9.4%) had wound complications, from which one patient had diabetes and one patient continued to smoke. Patients, who had early fixation, were not noted to have any wound complications post-operatively. The results were not noted to be clinically significant for the primary outcome between the two groups.
Conclusions and Recommendations: Due to pressures within the NHS, hospitals can struggle to achieve the target of performing ankle ORIF within day one of the injury. Furthermore, delaying the surgery by a few days can results in further swelling or formation of the blisters, which can delay the surgery even further. Although the results of this study did not observe any clinically significant difference between the two groups, this study is limited by small sample size overall. Hospital should aim to develop pathways that would help to perform ankle ORIF within one day of the injury.
