Timing of fracture fixation in ankle fracture-dislocations

Abstract

Abstract Purpose Ankle fracture-dislocations are the result of high energy trauma with concomitant soft tissue damage and may require delayed internal fixation. Our aim was to compare the use of acute ORIF with delayed ORIF, using external fixation or cast splint in ankle fracture-dislocations. We identify which factors affect the rates of re-operation and SSI. Methods In this retrospective cohort study, we included patients with open and closed ankle fracture-dislocations treated with ORIF from two large peripheral hospitals and one academic centre in the Netherlands. We used binary logistic regression for univariate and multivariate analyses to calculate which factors influence outcome. Results We included 447 patients with an ankle fracture-dislocation. In the multivariate analysis, the difference between surgery <48 hours compared to bridging with cast or external fixation had no significant influence on unscheduled re-operation or SSI. Higher Body Mass Index (BMI) and open fractures had a significant positive correlation with re-operation and diabetes mellitus (DM) and open fractures correlated with SSI. In patients with open fractures, there was also no significant difference in outcome between acute or delayed internal fixation. Conclusion We suggest that it is safe to perform primary ORIF on all dislocated ankle fractures if the soft tissue injury allows surgery within 48 hours. When significant swelling is present, temporary immobilization is a safe option to allow for surgery. Patients with well-reduced fractures and with no soft tissue injury could be treated safely with a cast until delayed ORIF is possible.