What Is the Ideal Timing for Surgical Intervention for Ankle Fractures? Advances

What Is the Ideal Timing for Surgical Intervention for Ankle Fractures?

A recent poster at the American College of Foot and Ankle Surgeons’ Annual Scientific Conference presented research on the ideal timing of surgical intervention for ankle fractures.1 With a unique study design eliminating certain confounding factors, the study found that soft tissue infections were not significantly different with surgical intervention before or after 7 days from injury.
 

Ideal Timing to Surgical Intervention of Ankle Fractures from HMP on Vimeo.

The authors acknowledged that time to surgery can be influenced by several metrics including OR availability, the soft tissue condition, and social factors. However, the current literature is divided as far as when to provide necessary surgical intervention. Brandon K. Kim, DPM, AACFAS, Aarron Flowers, DPM, AACFAS, and Brandon Lindberg, DPM, FACFAS undertook this retrospective cohort study of cases from 6 podiatric surgeons in a single medical group. They identified patients aged 18-60 for inclusion by CPT code over more than a 6-year period, and all patients had a minimum of 1 year of follow up. Individuals with a history of diabetes, rheumatoid arthritis, IV drug abuse, smoking, or pilon fractures were excluded. Two of the authors reviewed the charts for complications including surgical site infection (requiring postoperative antibiotics) and delayed wound healing (time to suture removal). They used Fisher’s Exact tests for statistical analysis.
 

More Insights on Ankle Fracture Fixation Timing from HMP on Vimeo.

The inclusion criteria led to 390 procedures in 296 patients, with an average age of 46.2 years, and an average time to surgery of 4.4 days. Over three-quarters of the patients underwent surgery within 7 days from injury. The authors found no significant differences in soft tissue infection rates or wound healing time whether the patient had open reduction and internal fixation (ORIF) more or less than 1 week from initial injury. The type of ORIF performed also did not reveal statistical significance. The only cohort identified with a higher infection rate was trimalleolar fractures with posterior malleolar fixation.
 

Lessons Learned on the Timing of Surgical Intervention for Ankle Fractures: A Poster from the ACFAS Annual Scientific Conference from HMP on Vimeo.

Although they advocate for further randomized controlled trials, the authors concluded that by excluding certain comorbidities, age ranges, and injury types, they provided focused data on the topic. They also note that as far as they are aware, this study is the largest of its kind that primarily isolates soft tissue complications with a 7 day parameter. The study contends that ORIF in this type of population may take place safely in an outpatient setting, possibly positively impacting health care spending and surgeon quality of life. The authors also support the existing consensus that states that there is no ideal timing for ORIF in the absence of fracture blisters or open wounds.

Reference

1. Kim BK, Flowers A, Lindberg B. Ideal timing to surgical intervention of ankle fractures. Poster presented at American College of Foot and Ankle Surgeons Annual Scientific Conference. February 2023. Los Angeles, CA

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