Abstract
Introduction
Excessive soft tissue swelling will delay surgery for a proportion of patients admitted with ankle fractures. Surgical and anesthetic teams may waste time assessing patients destined to be cancelled due to swelling. The aim of this investigation was to determine factors associated with cancellation.
Methods
Case notes of 87 patients (46 male, 41 female), mean age 43 years (range, 13 to 80) who underwent ankle fracture fixation were retrospectively analysed. 31 of 87 ankles (36%) were unsuitable for day after admission surgery due to swelling. Factors investigated included age, gender, mechanism of injury, fracture configuration and necessity for reduction on arrival in the emergency department due to dislocation; each factor was independently analysed for significance using Fisher's exact test.
Results
Ankle fractures associated with a higher energy injury such as sports, falls from height and road traffic accidents were significantly more likely than simple slips to be cancelled due to excess swelling the following morning (p = 0.053). Tri- or bi-malleolar ankle injuries and fracture dislocations requiring manipulation in the emergency department were also significant risk factors for cancellation (p = 0.004 and p = 0.002 respectively). Patients presenting with at least two of these factors demonstrated a 71% probability of cancellation the following day (17 of 87 patients). Presence of three risk factors increased the probability of cancellation to 100% (3 of 87 patients).
Conclusion
Cancellation on the day of surgery wastes time and causes patient distress. During busy on-call periods patients with all three risk criteria will almost certainly be too swollen for next day surgery. With the proviso that these fractures are immobilised in an acceptable position, patients could be rested with elevation and rebooked for surgery as opposed to being assessed and subsequently cancelled due to soft tissue swelling the day after injury.
