Impact of timing of surgery on wound complications and re-operations following closed ankle fracture fixation: a systematic review and meta-analysis.

BACKGROUND

The optimal timing of surgical fixation for closed ankle fractures remains uncertain. Advocates of early surgery suggest it enables faster rehabilitation without additional soft tissue insult, whereas delayed surgery is often favoured due to concerns about wound complications in the presence of swelling. This systematic review evaluated whether surgical timing influences wound complications and unplanned reoperation rates.

METHODS

Multiple databases were searched for RCTs and cohort studies. Primary outcomes were wound complications and unplanned re-operation events. Two reviewers independently screened, assessed quality, and extracted data. Random effects meta-analysis was performed.

RESULTS

Nine studies were included. Three reported significantly fewer wound complications with earlier fixation: within 24 hours (0/60 vs 16/145, p=0.004), four days (6.4% vs 18.6%, p=0.02), six days (2/56 vs 6/29, p=0.01), and seven days (2/98 vs 14/107, p=0.003). However, pooled analyses showed no differences at thresholds of 24 hours (RR 1.04, 95%CI 0.95-1.14, p=0.41), five days (RR 1.03, 95%CI 0.96-1.09, p=0.43), or seven days (RR 1.10, 95%CI 0.99-1.21, p=0.06). Four studies assessed unplanned reoperation; none found significant differences, and pooled analysis showed no difference between surgery performed within versus after five days (RD 0.04, 95%CI -0.07-0.15, p=0.49).

CONCLUSIONS

There is low quality evidence from three of nine studies suggesting that earlier fixation is associated with relatively reduced wound complications, but most studies showed no difference. No association was observed with unplanned reoperation. A large, prospective trial powered to wound complications is required to clarify causality. An RCT powered to investigate these outcomes is required to clarify causality.