The influence of pre-operative reduction quality on post-operative wound complications in ankle fractures: A review of 247 cases.

Abstract

Opinions vary on the definition of an adequate pre-operative reduction for unstable ankle fractures that require surgical fixation. We hypothesized that residual tibiotalar subluxation may impair post-operative wound healing. This study aimed to evaluate the influence of pre-operative reduction quality on the rate of wound complications following ankle fracture fixation. A retrospective cohort study of consecutive ankle fractures in adults treated with surgical fixation at a district general hospital from January 2020 until July 2023 was conducted. Pre-operative reduction was categorized as inadequate if there was residual tibiotalar joint subluxation of > 2mm on post-manipulation radiographs. Wound complication was defined as any wound problem requiring additional dressing care, antibiotics, or a return to the operating room. Two hundred and forty-seven patients were included in this study, with a median age of 56.9 (range 18.3 - 88.7). One hundred and sixty-six (67.2 %) patients were female. The median follow-up duration was 12.3 (range 2 - 148). Ninety-eight (39.7 %) patients had an inadequate pre-operative reduction. There were 29 (11.7 %) cases of post-operative wound complications. The rate of wound complications was higher in patients with an inadequate pre-operative reduction compared to those in whom adequate reduction was achieved (17.3 % versus 8.1 % respectively, p = 0.03). Persistent pre-operative tibiotalar joint subluxation was associated with an increased rate of wound complications following ankle fracture fixation. Initial closed reduction should aim to restore the tibiotalar alignment for soft tissue resuscitation. Urgent intervention is warranted in cases with persistent subluxation despite initial attempts at closed reduction.