A prospective audit was conducted at an associate teaching hospital in the south west to assess the outcome of operative treatment of ankle fractures of all patients over the age of 50 years in the last 2 years.

The aim of the study was to assess whether change in timing of surgery for ankle factures in accordance with the CEPOD guidelines has affected the outcome in terms of early complications. This is a follow up paper to the one published from this institution in 1994 (data 1988 to 1989). Since then the CEPOD rules have led to changes in theatre protocols, so very few ankles are fixed out of hours. Over this period there has been the emergence of MRSA which was not a problem in the 1990s.

We retrospectively reviewed the notes and x-rays for 107 consecutive patients older than 50 years who had their ankles fixed over a period of 2 years spanning 2003 to 2004. Our series had 12.1% incidence of clinical infections, 15.9% delayed wound healing as compared to 1.8% and 5.2% in previous publication from this institution. In our study 17.7% of ankles were fixed within 24 hours as opposed to 84.2 % in the previous paper. All of the infected wounds (100%) occurred in patients who had their operations 48hrs or more post injury. We also came across 2 cases of MRSA infection in our series.

We are concerned that changes in CEPOD rules as well as new hospital practice has resulted in delays in time to fixation. This seems to be the only variable to result in increased infection rates and delays in wound healing leading to increase in hospital stay and reoperations.