Open Reduction And Internal Fixation Of Ankle Fractures - Is Timing Of Surgery Important?

Objective: To determine the frequency of surgical site infection in ankle fractures fixed earlier or delayed. Methodology: This retrospective cohort study was conducted in the department of Orthopaedics and Traumatology Lady Reading Hospital Peshawar from March 2016 to August 2018. The medical records of all the patients with ankle fractures fulfilling the inclusion criteria were analyzed retrospectively. Demographic details of the included subjects, time of surgery and frequency of surgical site infection was noted. Results: A total of 128 patients with mean age 38.8 years± SD 9.76(range 18-58 years) were included in our study. Male patients were 99 (77.3%) while female were 29 (22.6%). The number of patients who had open reduction and internal fixation (ORIF) within the initial 24 hours after sustaining the fractures were 12 (9.3%) in number,58(45.6%) patients had surgery in 24 to 48 hours, 40 (31.4%) in 3 to 7 days and 18 (14.1%) had surgery in 8 to 14 days after the injury.The frequency of surgical site infection(SSI) was 42.5% (17/40) in patients operated in 3 to 7 days, 44.4%(8/18) in patients operated in 8 to 14 days while no surgical site infection was reported in 54.6% (70/128) patients operated in 24 to 48 hours. (P value < 0.05). Conclusion: The timing of ankle fracture surgery is very important. Open reduction and internal fixation of ankle fractures done earlier had no surgical site infection. Delayed fixation is associated with higher frequency of surgical site infection.