Aim. The purpose of this study is to analyze the demographic and microbiological variables of acute ankle infections posterior to ankle osteosynthesis and to determine the different characteristics of patients withE. cloacae infection. Method. A multicenter retrospective observational study (4 national hospitals) of acute post osteosynthesis infections of ankle fracture operated between 2015 and 2018 was implemented. The demographic and microbiological variables relating to the surgical intervention and the antibiotic treatment performed were collected. A descriptive assessment of all the variables and a univariate comparison between patients with E. cloacae infection and patients with alternative microorganism infections were performed. The SPSS v25 program for Windows was the choice for statistical analysis. Results. 71 Patients with an average age of 57 years were included, the majority being males (55%). 31% of patients were diabetic, 27% had vascular pathology, and 18.3% had a BMI greater than 35. Trimalleolar fracture was the most common in our study being 52%. 26.8% were open fractures. The microorganisms isolated were: 25% S. aureus, 22.5% E. cloacae and 22.5% polymicrobial. Accounting for polymicrobial infections, the presence of E. cloacae rises to 32%. In the univariate analysis, only significant differences were found in age (patients with E. cloacae infection were older) and the use of VAC therapy. Conclusions. In our series, higher percentages of E. cloacae infection were observed than those described in the literature. There are statistically significant differences in the variables of age and need for VAC therapy. The high incidence of E. cloacae infections suggests the vital importance of adapting antibiotic prophylaxis, ensuring the coverage of this microorganism

The most important determinant in the treatment of malleolar fractures is stability. Stable fractures have an intact deep deltoid ligament and do not displace with functional treatment. If the deep deltoid/medial malleolar complex is disrupted, the talus is at risk of displacement. Weber (2010) showed that weightbearing radiographs predicted stability in patients with undisplaced ankle fractures. We developed clinical criteria for potential instability and applied them to a prospective series of patients. Criteria included: medial clear space of < 4mm; medial tenderness, bruising or swelling; a fibular fracture above the syndesmosis; a bimalleolar or trimalleolar fracture; an open fracture; a high-energy fracture mechanism. A consecutive, prospectively documented series of 37 patients chose functional brace treatment of potentially unstable fractures. Weightbearing radiographs were performed in the brace before treatment, and free of brace at clinical union (6–9 weeks in all patients). Patients were encouraged to bear full weight and actively exercise their ankles in the brace. All fractures healed without displacement. The risk of displacement was 0% (95% CI 0–11.2%). This preliminary series gives support for the use of weightbearing radiographs to guide treatment of undisplaced ankle fractures

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 1. st. Jan 2008 – 31. st. 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