Cost benefit with early operative fixation of unstable ankle fractures.
BACKGROUND
Ankle fractures are common and many require surgical intervention. It has been well documented that a delay in fracture fixation results in increased length of hospital stay and increased complication rate. Initial delay can also allow swelling or blistering to develop which may necessitate a further delay in operative fixation for up to 1 week. The aim of the current study was to review the length of hospital in-patient stay for operative ankle fractures over the previous 12-month period at our hospital and compare this to the length of hospital stay following the introduction of a fast-track system for the fixation of these fractures (all fractures fixed within 48 h).


METHODS
A retrospective review of all ankle fractures managed by open reduction and internal fixation over a 12-month period was undertaken. A protocol was then agreed to openly reduce and fix these fractures at the earliest possible opportunity over the next 6-month period. We then collected the data on all ankle fractures that needed open reduction and internal fixation over this 6-month period. The pre-protocol and post-protocol groups were then compared for total hospital length of stay and complication rate.


RESULTS
In the 12-month retrospective review, there were 83 ankle fractures that required surgical intervention. Sixty-two of these had surgery within 48 h (mean length of stay, 5.4 days), and 21 had surgery after 48 h (mean length of stay, 9.5 days). There were 39 ankle fractures in the post-protocol group who all had surgery within 48 h (mean length of stay, 5 days). There was no increase in complication rate after implementation of the fast-track system.


CONCLUSIONS
This study shows that early operative intervention for ankle fractures reduces the length of hospital stay. Intensive physiotherapy and co-ordinated discharge planning are also essential ingredients for early discharge. Early operative fixation for unstable ankle fractures has substantial cost-saving implications with no increase in complication rate.
Pietzik
P
P
Department of Orthopaedics, St Peter's Hospital, Chertsey, Surrey, UK.
Qureshi
I
I
Langdon
J
J
Molloy
S
S
Solan
M
M
D000328:Adult; D016512:Ankle Injuries / Q000191:economics / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D005592:Fracture Fixation / Q000191:economics*; D050723:Fractures, Bone / Q000191:economics / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D017060:Patient Satisfaction; D012189:Retrospective Studies