The timing of ankle fracture surgery and the effect on infectious complications; A case series and systematic review of the literature |
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Authors: | Tim Schepers Mark R De Vries Esther M M Van Lieshout Maarten Van der Elst |
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Institution: | 1. Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, Room H-822k, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands 2. Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands 3. Department of Surgery and Traumatology, Reinier de Graaf Groep Delft, Delft, The Netherlands
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Abstract: | PurposeInformation about the influence of delayed surgery on infectious wound complications is ambiguous. A clinical audit was performed to test the hypothesis that early surgery lowers the rate of infectious wound complications. Secondly we looked at the influence of surgical delay and complications on patient reported functional outcome.MethodsAll consecutive, closed distal fibular fractures treated surgically with a plate were included and retrospectively analysed for the delay in operation and wound complications. In a second cohort of patients with a AO-Weber B-type ankle fracture outcome was measured using the Olerud-Molander ankle score (OMAS), the American Orthopaedic Foot and Ankle Society score (AOFAS) and a visual analog score (VAS) for overall satisfaction.ResultsPatients treated within one day experienced no wound complications (zero out of 60), whereas in the delayed group 11 % (16/145) did (p?=?0.004). A similar significant difference was found for the patients treated within one week (2/98) versus after one week (14/107). A systematic review of the literature showed a difference in wound complications of 3.6 % (early) versus 12.9 % (late) (p?0.0001). After 43 months, the median AOFAS was 11.5 points lower in the complication group, the OMAS 10 points, and the VAS 0.5 points, with all differences being statistically significant.ConclusionsEvery effort should be made to operate on closed ankle fractures as soon as reasonably possible. A delay in surgery is associated with a significant rise in infectious wound complications, which significantly lowers outcome and patient satisfaction. These fractures should preferably be treated within the first day. |
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