BOSTON — Researchers found preoperative ankle swelling and time to surgery were not associated with a change in soft tissue outcomes after ankle fracture surgery. The study also revealed few postoperative wound complications.
Anthony Silva, MBBS, MSc, presented the findings at the American Orthopaedic Foot & Ankle Society Annual Meeting. Silva and colleagues performed a prospective cohort study of 50 patients who were operatively managed for malleolar ankle fractures. The on-call attending orthopedic surgeon determined the time to surgery. The validated figure-of-eight measurement was used to measure ankle swelling in the operative and nonoperative limbs.
To eliminate bias between operators and to standardize measurements between patients, investigators used the ratio of a patient’s two ankles to measure the swelling. Investigators also performed a visual assessment of the swelling. Follow-up visits were at 2, 6 and 12 weeks and wound complications, patient comorbidities, operative time, surgeon experience and hospital stay duration were recorded.
There was a 4% complication rate. This included superficial wound infections that required oral antibiotics and wound episodes for treatment. The mean time to surgery was 6 days. Ankle swelling and time to surgery was not significantly different between patients with wound complications vs. patients without wound complications. No significant differences were seen between patients with complications vs. those without with regard to BMI, smoking status, diabetes and peripheral vascular disease. Also, patients with wound complications and those without were not significantly different with regard to the level of operating surgeon, operative time, tourniquet time and closure material.
“So, the big question: Do we need to wait for ankle swelling to resolve before we proceed with ankle fracture surgery?” Silva said during his presentation. “Our simple answer is no. Delaying operative fixation for swelling may be unnecessary and proceeding with fixation, regardless of swelling, is safe.”
He added, “But, please keep in mind that increasing age is a predictor for wound complications even though that is independent of ankle swelling, and we should use caution in this population. If we are going to proceed with delaying operative management for swelling, please keep in mind that out visual assessments aren’t as good as we think they are.” – by Monica Jaramillo
Silva A, et al. Preoperative ankle swelling and the effect on postoperative wound complications following ankle fracture surgery. Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting; July 11-14, 2018; Boston.
Disclosure: Silva reports no relevant financial disclosures.