VERSUS DELAYED TREATMENT OF SEVERE ANKLE FRACTURES - A COMPARISON OF RESULTS

A retrospective review of 202 closed Weber B bimalleolar or bimalleola r equivalent ankle fractures treated using open reduction and internal fixation (ORIF) from January 1, 1991, through January 1, 1994 was com pleted at our institution. A total of 105 ankles (52%) were treated us ing ORIF within 5 days of injury (early group), with a mean 1.5 days f rom injury to surgery. A total of 97 ankles (48%) were treated after 5 days (delayed group), with a mean of 13.6 days from injury to surgery . Operative time, length of hospital stay, postoperative range of moti on, adequacy of reduction, wound and other complications, and other se quelae were compared between the two groups. No significant difference in range of motion at latest follow-up or in operative time was evide nt between the groups. Minor wound complications were present in 4.8% of the early group compared with 6.2% in the delayed group. No deep in fections or osteomyelitis were present in either group. Anatomic reduc tions were present in 89% and poor reductions (>2 mm displacement) in 1% of those ankles treated within 5 days versus 83% anatomic reduction s and 3% poor reductions in those treated after 5 days. The difference s in wound complications and anatomic reductions between groups was no t statistically significant. There was a significantly longer median h ospital stay in the early (3 days) versus delayed groups (2 days). We conclude that the results and complications of early versus delayed tr eatment is not significantly different, except for a shorter median ho spital stay in the delayed group. Delayed ORIF is an acceptable altern ative when soft-tissue swelling, fracture blisters, or abrasions are p resent that offer an undesirable environment for surgical incisions. U sing contemporary, atraumatic techniques, delayed surgery can provide anatomic reduction with minimal complications in severe ankle fracture s.