Abstract
Introduction
The aim of this study was to compare the results and length of stay of patients of early (within 12 hours) versus conventional (after 48 hours) ankle fixation our hospital.
Methods of study
It was a retrospective study over 18 month period (July 2004 - Dec 2005) including 200 Patients (aged 16 or more). We looked into age, place of living, Weber classification, mechanism of injury, comorbidities especially diabetes, addictions mainly smoking, etc. Overlying skin condition, the amount of swelling at presentation, associated ankle dislocation or talar shift, acute medical comorbidities, injury types-open or closed were classified accordingly.
Results
Out of 200 patients, only twenty-two had surgery done within 12 hours (mean length of stay, 3.3 days), and sixty-seven of these had surgery within 48 hours (mean length of stay, 4.9 days), while 111 had surgery after 48 hours (mean length of stay, 9.4 days). Finally we calculated the extra cost (784 bed days - £235,000) incurred to the trust in terms of extra bed occupancy and treating the complications as a result of wait. Main reasons for delay in theatre and discharge were swelling and blisters, delay in transit from Bournemouth A&E, delayed presentation, unavailability of theatre time or cancellation, further imaging required or senior opinion awaited.
Conclusion
This study shows that initial delay may cause swelling and blistering to develop which mandates a further delay. Our message about ankle fractures is not to miss the boat and operate before the swelling appears. We want to emphasise on the ‘Window of Opportunity’ ie initial 12 hours to fix the ankle fractures to decrease overall morbidity and cost.
