Association of Delayed Surgery for Ankle Fractures and Patient-Reported Outcomes

Abstract

Background: Several studies probe the association between prolonged time to surgery and postoperative complications in ankle fractures, but little is known about how a longer wait time affects clinical outcomes. The present study aims to assess the association between time from injury to surgery and patient-reported outcomes after operative treatment of severe ankle fractures. Method: Patients treated operatively for low-energy ankle fractures that also involve the posterior malleolus from 2014 to 2016 were included. Patient charts were reviewed for patient demographics, type of trauma, fracture characteristics, treatment given, and complications. Ankle function was evaluated on a follow-up visit by clinical examination, radiographs, and patient-reported outcome measures (Self-Reported Foot and Ankle Score [SEFAS], RAND-36, visual analog scale [VAS] of Pain, VAS of Satisfaction). We compared patients treated within 1 week to those treated later than a week from injury for analyses. Results: Follow-up visits of 130 patients were performed at mean 26 (SD 9) months after surgery. Patient demographics and fracture characteristics were similar between groups. Mean SEFAS was 34 (SD 10) in patients treated later than a week from injury vs 38 (SD 9) in those treated earlier ( P = .012). Patients operated on later than 7 days from injury reported more pain ( P = .008) and lower satisfaction than those treated earlier ( P = .016). Conclusion: In this retrospective patient series of low-energy ankle fractures with posterior malleolar fragments, we found that waiting >7 days for definitive surgery was associated with poorer clinical outcomes and more pain compared with those who had surgery earlier. Level of Evidence: Level III, retrospective comparative study.

Temporary Cast Application in Dislocated Ankle Fractures Leads to High Rates of Secondary Loss of Reduction: Does the Lauge-Hansen Injury Type Matter?

“…Despite the absence of studies specifically evaluating the impact of surgery timing on outcomes and complications in ankle fractures, existing research suggests that earlier surgery for ankle fractures, in general, significantly affects both outcomes and complication rates positively. 15,18 Conflicting results exist regarding the influence of the posterior malleolar size ratio on LOR, with our study unable to derive specific recommendations for a cutoff value. 6,12 The literature's heterogeneity stems from several factors:…”

“…Despite the absence of studies specifically evaluating the impact of surgery timing on outcomes and complications in ankle fractures, existing research suggests that earlier surgery for ankle fractures, in general, significantly affects both outcomes and complication rates positively. 15,18…”

Construction and validation of a nomogram prediction model for postoperative incisional infection in ankle fractures

“…Surgery is the main and most effective treatment for ankle fractures. [6][7][8] However, due to anatomical reasons, [9,10] the soft tissues in the ankle joint are relatively weak and the blood supply is poor, which leads to a high risk of infection in the postoperative incision of the ankle joint. According to studies, the incision infection rate after ankle fractures is high.…”

No delay in care of ambulatory orthopaedic fractures observed during the early Coronavirus-2019 pandemic: a retrospective cohort study

“…Delays in treatment can result in changes to management, malunion, and increased complications. [5][6][7][8][9] The goals of this study were to characterize the volume of ambulatory orthopaedic fractures that presented to a clinic and the emergency room immediately after the initial implementation of social distancing practices. The authors hypothesized that there would be an overall increased delay in care for ambulatory orthopaedic fracture patients during the early COVID-19 pandemic.…”

“…The treatment of many orthopaedic fractures, both operatively and nonoperatively, requires timeliness to allow for appropriate reduction and maintenance of alignment to allow for healing. Delays in treatment can result in changes to management, malunion, and increased complications 5–9…”