Abstract
The timing of surgery in treating closed ankle fractures requiring open reduction and internal fixation is dependent upon soft tissue swelling. At Exeter in 2001 one third of all trauma cases were operated on “out of hours,” in 2007 this was less than 10%, principally as a result of the lack of anaesthetic staff. The senior author has developed a technique of minimally invasive percutaneous plate osteosynthesis for ankle fracture fixation that may be undertaken at an early stage, despite the presence of swelling.
In a retrospective study 25 patients fixed with percutaneous osteosynthesis over four years were compared with a cohort of 25 patients selected at random who had undergone standard open reduction and internal fixation in the same time period. Particular attention was paid to time to surgery, time to discharge and complications. Patients undergoing percutaneous fixation were found from the hospital database. One patient was excluded because of a delay to surgery whilst being treated on the intensive care unit. Admission documentation, operation notes and clinic letters were used to ascertain the outcome. Pre and post-operative imaging was evaluated.
Over a four-year period the senior author performed minimally invasive percutaneous plate osteosynthesis on a total of 25 patients. The mean time to surgery was two days for the percutaneous cohort (range 0–5 days) compared with 4.1 days for the open cohort (range 1–11). Time to discharge was 4.2 days as opposed to 6.2 in the percutaneous group. There were no complications in the percutaneous cohort, as opposed to three in the standard cohort.
Preliminary results demonstrate a reduced waiting time for surgery and a quicker discharge when using minimally invasive percutaneous plate osteosynthesis technique for ankle fracture fixation. We believe that our institution is the first to develop this technique. Percutaneous fixation is an option when swelling precludes open surgery.
Correspondence should be addressed to A.H.N. Robinson, BOX 37, Department of Orthopaedics, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge. CB2 0QQ, England.
