Timing of Open Reduction and Internal Fixation of Ankle Fractures

Transcription

1 Timing of Open Reduction and Internal Fixation of Ankle Fractures Direk Tantigate, MD, Gavin Ho, BA, Joshua Kirschenbaum, Christina E Freibott, BA, Benjamin Ascherman, BA, Justin K Greisberg, MD, J. Turner Vosseller, MD. Department of Orthopaedic Surgery, Columbia University Medical Center, NY, USA

2 No Conflicts to Disclose Direk Tantigate, MD, Gavin Ho, BA, Joshua Kirschenbaum, Christina E Freibott, BA, Benjamin Ascherman, BA, Justin K Greisberg, MD, J. Turner Vosseller, MD. Our disclosures are in the final AOFAS app. We have no potential conflicts with this presentation. 2

3 Background It is not uncommon for operative treatment of ankle fractures to be performed as an scheduled ambulatory setting several days to a couple of weeks after the injury The effect of this delay on wound complication and functional outcome still remains unclear This study aimed to assess the impact of delayed open reduction and internal fixation (ORIF) of ankle fractures on wound complication and functional outcomes 3

4 Material and Methods A retrospective chart review of 121 patients who underwent ORIF of ankle fractures was performed Three patients were excluded; 2 open injury and 1 delayed union The cutoff time for delay surgery was 14 days after injury Postoperative wound complication in 3 months were recorded 58 patients, who had a duration of follow-up 24 months, were subsequently analyzed for the functional outcome Functional outcome was assessed by Foot and Ankle Outcome Score (FAOS) at the last follow up visit 4

5 Material and Methods The median age was 48 years (range, 19-85) 59.4% (64 patients) were female The median time from injury to surgery was 7 days (range, 1-26) The median follow up was 38 months (range, 24-76) 5

6 Comparison of Patient Underwent Surgery < 14 and 14 Days Variables Surgery < 14 days Surgery 14 days P value (101 patients) (17 patients) Age (years, mean ± SD) 46 ± ± Gender: Female (n,%) 60, 59.4 % 8, 47.1%.341 Side (Left) (n,%) 53, 52.5% 9, 52.9%.972 ASA score (n,%) - ASA 1 - ASA 2 - ASA 3 33, 32.7% 58, 57.4% 10, 9.9% 4, 23.5% 9, 52.9% 4, 23.5% BMI (median, IQR) 28.63, , Diabetes (n,%) 14, 13.9% Current tobacco usage (n,%) 8, 7.9% Type of fracture (n,%) - Distal fibular - Bimalleolar equivalent - Bimalleolar - Trimalleolar 33, 32.7% 12, 11.9% 41, 40.6% 15, 14.9% 6, 35.3% 7, 41.2% 3, 17.6%.901 6

7 Comparison of Patient Underwent Surgery < 14 and 14 Days Variables Surgery < 14 days (101 patients) Surgery 14 days (17 patients) P value Weber classification (n,%) Type B - Type C 71, 70.3% 30, 29.7% 12, 70.6% 5, 29.4% Syndesmosis injury (n,%) 27, 26.7% 4, 23.5%.781 Fracture-dislocation (n,%) 31, 30.7% 2, 11.8%.108 Time from injury to surgery (days, 6, , <.05 median, IQR) Type of fibular fixation (n,%) Posterior plating - Lateral plating - Dual plating - intramedullary screw 79, 78.2% 18, 17.8% 3, 3.0% 1, 1.0% 15, 88.2% Operative time (min, median, IQR) 90, , Length of stay (days, median, IQR) 1, 0-3 1, Admission status (n,%) 62, 61.4% 9, 52.9%.511 7

8 Comparison of Patient Underwent Surgery < 14 and 14 Days Variables Subsequent complication (n, %) - Wound complication - Deep venous Thrombosis - Neurapraxia - Surgical site infection - Nonunion - Posttraumatic arthritis Wound complication (n, %) - Wound erythema - Wound dehiscence - Surgical site infection Subsequent operation (n,%) - Hardware removal - Debridement - Osteophyte resection - Ankle replacement Surgery < 14 days (101 patients) 4, 4% 3, 3% 20, 19.8% Surgery 14 days (17 patients) 2, 11.8% P value

9 Comparison of FAOS between Surgery < 14 and 14 Days Variables Surgery < 14 days Surgery 14 days P value ( 47 patients) (11 patients) FAOS score (median, IQR) - Symptoms 78.57, , Pain 86.11, , Activities of daily living 94.85, , Sports 75, , Quality of life 59.38, ,

10 Discussion Wound complication did not significantly increased in patients who underwent ankle ORIF after 14 days Delayed operative treatment of ankle fracture ORIF after 14 days did not worsening the functional outcome according to FAOS compare to surgery within 14 days Further analysis on the cutoff point at 7 and 10 days also demonstrated no significant difference in functional outcome according to FAOS 10

11 Reference 1. Adamson SP, Trickett R, Hodgson P, Mohanty K. Ankle fractures: impact of timing of surgery. Inj Extr. 2009;40(10): James LA, Sookhan N, Subar D. Timing of operative intervention in the management of acutely fractured ankles and the cost implications. Injury. 2001;32(6): Konrath G, Karges D, Watson JT, Moed BR, Cramer K. Early versus delayed treatment of severe ankle fractures: a comparison of results. J Orthop Trauma. 1995;9(5): Hoiness P, Engebretsen L, Stromsoe K. The influence of perioperative soft tissue complications on the clinical outcome in surgically treated ankle fractures. Foot Ankle Int. 2001;22(8): doi: / James LA, Sookhan N, Subar D. Timing of operative intervention in the management of acutely fractured ankles and the cost implications. Injury. 2001;32(6): Konrath G, Karges D, Watson JT, Moed BR, Cramer K. Early versus delayed treatment of severe ankle fractures: a comparison of results. J Orthop Trauma. 1995;9(5): Saithna A, Moody W, Jenkinson E, Almazedi B, Sargeant I. The influence of timing of surgery on soft tissue complications in closed ankle fractures. Eur J Orthop Surg Traumatol. 2009;19: doi: / s Schepers T, De Vries MR, Van Lieshout EM, Van der Elst M. The timing of ankle fracture surgery and the effect on infectious complications; a case series and systematic review of the literature. Int Orthop. 2013;37(3): doi: /s Shah NH, Sundaram RO, Velusamy A, Braithwaite IJ. Five-year functional outcome analysis of ankle fracture fixation. Injury. 2007;38(11): doi: /j.injury Singh B, Balaratnam S, Nauidu V. Early versus delayed surgery for ankle fractures: comparison of results. Eur J Orthop Surg Traumatol. 2005;15(1): doi: /s Singh RA, Trickett R, Hodgson P. Early versus late surgery for closed ankle fractures. J Orthop Surg (Hong Kong). 2015;23(3):