Abstract
AIM
To evaluate patient outcomes in surgically managed ankle fractures with respect to fracture pattern, timing of surgery and length of stay.
METHOD
A retrospective review was undertaken of all patients admitted with an ankle fracture requiring a surgical procedure to our hospital between 1st Jan 2008 – 31st Dec 2008. Patient records were reviewed for baseline demographics and dates of admission, surgery and discharge. Radiographs were examined for fracture pattern and any evidence of dislocation.
Patients were grouped into either early surgery (<48hours), or delayed surgery (>48hours). Data was analysed for length of stay (total, pre- and post-operative), time to surgery and factors influencing timing of surgery.
RESULTS
One hundred and twenty-one patients were identified (12 were excluded for either failed conservative management or pre-op CT required), in all 109 patients were included. Average age was 46.5 years (range 11-83yrs) with a female predominance (ratio 3:1).
Average length of stay was 9.13 days, with a mean time to surgery 2.7 days. 44% had early surgery; 56% delayed surgery. Pre-operative bed days in the delayed surgery group totalled 278 (average 4.5days per patient).
Total length of stay was, on average, 1.1 days longer in the delayed surgery group, however, post-operative stay was significantly shorter in this group (4.93 versus 6.98 days). Factors associated with delayed surgery were trimalleolar fractures (p=0.06) and failure to reduce dislocation on first radiograph (p=0.27).
CONCLUSION
Post-operative stay is shorter when surgery is delayed beyond 48 hours. Patient throughput, total length of inpatient stay, cost and patient satisfaction could be improved with early discharge and semi-elective re-admission for fracture fixation.
Tri-malleolar fractures and delays in reduction after dislocation both pre-disposed to delayed surgery, owing to soft tissue swelling, and need to be pre-operatively managed accordingly.
