title: The timing of ankle fracture surgery and the effect on infectious complications; a case series and systematic review of the literature.
abstract: OBJECTIVE
  Information about the influence of delayed surgery on infectious wound complications is ambiguous. A clinical audit was performed to test the hypothesis that early surgery lowers the rate of infectious wound complications. Secondly we looked at the influence of surgical delay and complications on patient reported functional outcome.
  
  
  METHODS
  All consecutive, closed distal fibular fractures treated surgically with a plate were included and retrospectively analysed for the delay in operation and wound complications. In a second cohort of patients with a AO-Weber B-type ankle fracture outcome was measured using the Olerud-Molander ankle score (OMAS), the American Orthopaedic Foot and Ankle Society score (AOFAS) and a visual analog score (VAS) for overall satisfaction.
  
  
  RESULTS
  Patients treated within one day experienced no wound complications (zero out of 60), whereas in the delayed group 11% (16/145) did (p = 0.004). A similar significant difference was found for the patients treated within one week (2/98) versus after one week (14/107). A systematic review of the literature showed a difference in wound complications of 3.6% (early) versus 12.9% (late) (p < 0.0001). After 43 months, the median AOFAS was 11.5 points lower in the complication group, the OMAS 10 points, and the VAS 0.5 points, with all differences being statistically significant.
  
  
  CONCLUSIONS
  Every effort should be made to operate on closed ankle fractures as soon as reasonably possible. A delay in surgery is associated with a significant rise in infectious wound complications, which significantly lowers outcome and patient satisfaction. These fractures should preferably be treated within the first day.
authors.affiliation: Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, Room H-822k, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. t.schepers@erasmusmc.nl
authors.forename: Tim
authors.initials: T
authors.lastname: Schepers
authors.forename: Mark R
authors.initials: MR
authors.lastname: De Vries
authors.forename: Esther M M
authors.initials: EM
authors.lastname: Van Lieshout
authors.forename: Maarten
authors.initials: M
authors.lastname: Van der Elst
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000601:surgery*; D001860:Bone Plates; D005260:Female; D005360:Fibula / Q000293:injuries*; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult