Location
Philadelphia, PA
Start Date
30-4-2025 1:00 PM
End Date
30-4-2025 4:00 PM
Description
Introduction
Open ankle fractures are high-risk injuries with significant complications, including infection, wound dehiscence, and necrosis, often requiring multiple surgeries. This study evaluates early versus delayed fixation of clean, open medial malleolus fractures, hypothesizing no difference in infection rates between the two cohorts.
Methods
A retrospective chart review of 99 open ankle fractures involving the medial malleolus was conducted at a level 1 trauma center between November 2016 and July 2024. Fractures were divided into “Early” (immediate ORIF) and “Delayed” (ex-fix followed by ORIF) groups. Ankles were excluded if the fractures were closed, severely contaminated, polytrauma, and insufficient follow-up. Primary outcomes were infection rate, length of hospital stay, number of operations, and return to the operating room. Secondary variables include union rate, pain scores, time to weight bearing, antibiotic course, and wound care.
Results
Among 99 fractures, 55 underwent early fixation and 44 delayed fixation. Infection rates were 18% in the early group and 9% in the delayed group (p=0.19). Early fixation was associated with significantly shorter LOS (7.8 vs. 12.8 days; p=0.0004) and fewer operations (1.3 vs. 2.4; p< 0.0001). Union rates (95% early vs. 91% delayed; p=0.69) and symptomatic nonunion rates (4% early vs. 5% delayed; p=0.99) were similar. Wound care initiation was higher in the early group (56% vs. 27%; p=0.0037), but other secondary outcomes, including time to weight-bearing and pain levels, showed no differences.
Conclusion
Early fixation of clean open ankle fractures reduces LOS and the number of operations without increasing infection or nonunion rates. The higher incidence of wound care in early fixation highlights the importance of careful patient selection and soft tissue management. These findings suggest early fixation is safe and may improve resource utilization for appropriately selected cases.
Embargo Period
6-2-2025
Included in
The Effectiveness of Early vs Delayed Medial Malleolar Fixation in the Treatment of Open Ankle Fractures
Philadelphia, PA
Introduction
Open ankle fractures are high-risk injuries with significant complications, including infection, wound dehiscence, and necrosis, often requiring multiple surgeries. This study evaluates early versus delayed fixation of clean, open medial malleolus fractures, hypothesizing no difference in infection rates between the two cohorts.
Methods
A retrospective chart review of 99 open ankle fractures involving the medial malleolus was conducted at a level 1 trauma center between November 2016 and July 2024. Fractures were divided into “Early” (immediate ORIF) and “Delayed” (ex-fix followed by ORIF) groups. Ankles were excluded if the fractures were closed, severely contaminated, polytrauma, and insufficient follow-up. Primary outcomes were infection rate, length of hospital stay, number of operations, and return to the operating room. Secondary variables include union rate, pain scores, time to weight bearing, antibiotic course, and wound care.
Results
Among 99 fractures, 55 underwent early fixation and 44 delayed fixation. Infection rates were 18% in the early group and 9% in the delayed group (p=0.19). Early fixation was associated with significantly shorter LOS (7.8 vs. 12.8 days; p=0.0004) and fewer operations (1.3 vs. 2.4; p< 0.0001). Union rates (95% early vs. 91% delayed; p=0.69) and symptomatic nonunion rates (4% early vs. 5% delayed; p=0.99) were similar. Wound care initiation was higher in the early group (56% vs. 27%; p=0.0037), but other secondary outcomes, including time to weight-bearing and pain levels, showed no differences.
Conclusion
Early fixation of clean open ankle fractures reduces LOS and the number of operations without increasing infection or nonunion rates. The higher incidence of wound care in early fixation highlights the importance of careful patient selection and soft tissue management. These findings suggest early fixation is safe and may improve resource utilization for appropriately selected cases.