Abstract
Background and aims: The timing of open reduction and internal fixation of ankle fractures is controversial. Conventional teaching recommends either immediate surgery before 6 – 8 hours, or a delay of 4 – 6 days in order to minimise soft tissue complications. However, there have been no large studies to provide clear guidelines and the literature is conflicting. The object of this study was to investigate the complication rates after open reduction and internal fixation of ankle fractures at Lillehammer hospital. Specifically, we wanted to compare the infection rates of those patients who underwent immediate surgery with the group that had their surgery delayed. Furthermore we wanted to investigate if AO/ASIF s recommendations regarding timing of surgery after ankle fracture were followed. Patients and Methods: A retrospective review of ankle fractures treated using open reduction and internal fixation (ORIF) at Lillehammer hospital was undertaken. Case notes and plain radiographs of 281 patients between 1.1.2009-31.12.2013 were reviewed. Data was analysed using MS Access and Excel. Results: During the study period overall complication rate was 15 %. The overall infection rate was 9,8 %. The overall deep infection rate was 3,3 %. Deep infection rate in patients who underwent immediate surgery was 2,7 %,, (CI95%: 0 – 5,7) compared to 4,2 % (CI95%: 0,2 – 8,2) in the patients with delayed surgery. 86,7 % of the patients who underwent immediate surgery were operated on before 8 hours, while 90,8 % of the patients who underwent late surgery were operated on later 4 days. Conclusions: At Lillehammer hospital the AO/ASIF recommendations regarding timing of operation were followed to a high degree. 88,4 % of the patients are operated on either before 8 hours or after 4 days. However in the patient group that underwent delayed surgery 36,7 % had to wait more than one week before surgery was performed. Our study shows no significant differences in infection rate between the group that underwent delayed surgery and the group that underwent immediate surgery. We suggest that further studies are performed in order to answer whether or not operative timing is associated with the postoperative infection rate.