title: Early versus late surgery for closed ankle fractures.
abstract: OBJECTIVE
  To compare the outcome after early versus late surgery for closed ankle fractures in terms of the length of hospital stay and infection rate.
  
  
  METHODS
  Records of 95 men and 119 women aged 14 to 92 (mean, 46) years who underwent open reduction and internal fixation for ankle fractures during three 6-month periods in 2004, 2007, and 2010 were reviewed. 82 and 132 patients underwent surgery <24 hours and >24 hours after presentation, respectively. The most common reason for delayed surgery was unavailability of the operation theatre, followed by delayed admission to the fracture clinic and excess soft tissue swelling.
  
  
  RESULTS
  Patient and injury characteristics of the 3 study periods were comparable (p=0.399). The early and late surgery groups were comparable in proportions of various fracture patterns but not in patient age (40 vs. 49 years, p=0.002). The mean postoperative length of hospital stay was shorter in the early surgery group (2.9 vs. 5.5 days, p=0.009). The 2 groups did not differ significantly in the infection rate (7% vs. 11%, p=0.589) or the need for additional surgery (3.7% vs. 5.3%, p=0.63).
  
  
  CONCLUSIONS
  Patients with delayed surgery for ankle fracture had a longer postoperative length of hospital stay. Surgery should be performed within 24 hours of injury to minimise the length of hospital stay.
authors.affiliation: Department of Trauma and Orthopaedics, Robert Jones Agnes Hunt Orthopaedic Hospital, United Kingdom & Department of Trauma and Orthopaedics, University Hospital of Wales, United Kingdom.
authors.forename: Rohit Amol
authors.initials: RA
authors.lastname: Singh
authors.affiliation: Department of Trauma and Orthopaedics, University Hospital of Wales, United Kingdom.
authors.forename: Ryan
authors.initials: R
authors.lastname: Trickett
authors.affiliation: Department of Trauma and Orthopaedics, University Hospital of Wales, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Hodgson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult
keywords: ankle fractures; length of stay; time-to-treatment