ABSTRACT
The goal of this study is to evaluate the effect of time-to-surgery following closed
ankle fractures on long-term patient reported outcomes, fracture healing, and wound
complications. To date, little research has been done focusing on the impact “time
to definitive fixation” has on patient reported outcomes. We performed a retrospective
analysis of 215 patient records who underwent open reduction and internal fixation
(ORIF) for an ankle fracture from July 2011 to July 2018. A total of 86 patients completed
the patient reported outcome measurement information systems (PROMIS) survey at long-term
follow-up. Primary outcomes were the rate of delayed union, postoperative wound complications,
patient reported outcome measurement information system (PROMIS) pain interference
(PI), and physical function (PF) scores. No differences were found when comparing
time to surgery on a continuous scale with rates of delayed union, nonunion, or wound
complications (p = .84, .47, and .63, respectively). PROMIS scores were collected at a median of 4.5
years (2.0 interquartile range (IQR), range 2.5-12.3) postoperatively. The time from
ankle fracture to surgery was independently associated with worse PROMIS PI scores
(unstandardized β 0.38, 95% CI 0.07-0.68) but not PROMIS PF scores. Severe Lauge-Hansen
injuries were independently associated with decreased PROMIS PF scores (unstandardized
β −7.02, 95% CI −12.0 to −2.04). Increased time to surgical intervention and severe
Lauge-Hansen injuries were independently associated with worse long-term patient reported
outcomes. Surgical timing did not impact union rates or wound complications. Surgeons
should be aware that delaying ankle fracture repair beyond 12 days after injury may
negatively affect long-term patient reported pain scores.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: March 02, 2023
Publication stage
In Press Corrected ProofFootnotes
Financial Disclosure: The authors received no financial support for the research, authorship, and/or publication of this article.
Conflict of Interest: None reported.
IRB Approval: IRB approval was obtained by the University of Alabama in Birmingham. IRB-300000382, IRB-300000382-028.
Outcomes of Foot & Ankle Surgery.
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