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Early surgery for ankle fractures may improve outcomes, reduce costs
Sukeik M. Injury Extra. 2010;41:133-134. doi:10.1016/j.injury.2010.07.419.
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United Kingdom investigators suggest that hospitals establish a policy of early surgical intervention for ankle fractures, which would improve outcomes and reduce the costs associated with this injury.
Ankle fractures are one of the most common orthopedic injuries, according to Mohamed Sukeik, MD, MRCS, and colleagues at the Cumberland Infirmary, in the United Kingdom. The swelling associated with these fractures causes operative delays. However, a surgical delay of more than 24 hours after injury is linked to longer hospitals stays, which increases costs.
In this retrospective study, the investigators followed 145 consecutive patients who were treated for ankle fractures between January 2008 and December 2008. They excluded patients with talar and pilon fractures. There were 62 men and 83 women. The patients had a mean age of 49 years. To determine surgical delay, the investigators noted the time of emergency department presentation and the time of anesthetic. They reviewed patient notes for inpatient stay and postoperative complications.
The early group included 117 patients who were operated on within 24 hours of presentation. The delayed group included 28 patients operated more than 24 hours after presentation.
The mean inpatient stay for the early group was 3.79 days vs. 8.57 for the delayed group. In 57% of the delayed surgery group cases, swelling caused the delay. Surgery was also delayed because of a lack of operating room time and a lack of fitness for surgery.
Five patients (4.27%) in the early group had wound infections, and one patient had a chest infection (0.85%). In the delayed group, four patients (14.28%) had wound infections; all had ankle swelling.