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ABSTRACT: BackgroundThe timing of surgery for closed ankle fracture is controversial. Conventional teaching recommends either immediate surgery
or a delay of 5–7days in order to minimise soft tissue complications. However, there have been no large studies to produce
clear guidelines and the literature is conflicting. Some authors suggest that delayed surgery results in increased risk of
wound complications, less satisfactory rate of anatomical reduction, increased hospital stay and health service cost.
ObjectiveWe aimed to determine whether surgery can be safely performed in an intermediate time frame with respect to soft tissues complications.
MethodWe performed retrospective analysis of case notes and plain radiographs of 85 patients undergoing open reduction and internal
fixation for closed ankle fractures at our unit in 2004. Data were analysed using the StatView statistical analysis program.
ResultsThe overall incidence of infection in our population of 85 patients was 9.4%. This comprised seven superficial wound infections
and one deep infection. The incidence of infection in patients undergoing surgery after 6days was significantly higher than
those undergoing surgery earlier (3.6 vs 20.7%, χ2=6.57, P=0.010). Kaplan–Meier analysis showed a decreased cumulative probability of non-infection with increasing time.
ConclusionWe suggest that with experience, meticulous soft tissue handling and good operative technique, delaying surgery until swelling
has subsided completely is unnecessary in the majority of patients and is associated with a higher risk of wound complication.
European Journal of Orthopaedic Surgery & Traumatology 10/2009; 19(7):481-484. DOI:10.1007/s00590-009-0455-5 · 0.18 Impact Factor