This study compares the outcomes of early operative treatment (within one week of injury) versus delayed operative treatment (one week later) of closed ankle fractures in adults. The early treatment group had fewer wound infections, shorter hospital stays, and earlier weight bearing and return of range of motion compared to the delayed treatment group. However, both groups had similar times to radiological fracture union and functional outcomes. The study concludes that early operative treatment has benefits but delayed treatment can also provide good results.

1. A comparative study on early
versus delayed operative treatment
of closed ankle fractures in adult
Dr. Khoda Tada, PGT-III
Dept of Orthopaedics,
Rims, Imphal, Manipur

2. introduction
• most common lower limb fracture
• 9% of all fractures
• 122-184 per 100000 persons.
• young men and older women
• men below the age of 50
• twisting, fall, sports injuries and rta

3. cont….
• body weight is transmitted through it
• locomotion depends on stability of this joint
• timely intervention is a crucial factor
• patient late presentation
• scarcity of similar research
• important data for planning

4. materials and methods
• study design: quasi-experimental study.
• study setting: dept of orthopaedics rims,
imphal, manipur.
• study durations: 2 years from sept 2017
to aug 2019.

5. cont…
• study population: 30 patients
• sampling: Purposive sampling method
• study group: 15 patients each
 Early group - within one week of injury
 Delayed group - one week later

6. cont…
• inclusion criteria:
 closed displaced bimalleolar ankle
fractures
 above 18 yrs who gave consent.

7. cont…
• exclusion criteria:
 undisplaced fractures
 childhood and epiphyseal injuries around
ankle.
 polytrauma
 severe soft tissue injury with blisters
 medically unfit for surgery

8. cont…
• study variables:
 operative time, wound infection
 duration of post operative hospital stay
 clinical and radiological fracture union
 weight bearing ,range of motion
 functional outcome

9. cont…
• study tools:
 questionnaire proforma: c olerud and h molander
scoring scale
 x rays : siemens 500ma
 instruments :

10. cont…
• statistical analysis:
 independent t- test and chi- square test
 significant when the value is < 0.05
• ethical issue: approved
• conflict of interest: nil

11. operative procedures
• anaesthesia:
 spinal or general.
• positon:
 supine position
 affected limb in extended.

12. cont…
• tourniquet: applied
• skin preparations:
 soap scrub
 providone iodine (10%)
• drapping:
 with sterile gowns

13. cont…
• internal fixation: either
 partially threaded screw in medial malleolus
with 1/3rd tubular plate in lateral malleolus,
or
 tension band wiring in medial malleolus
with 1/3rd tubular plate in lateral malleolus.

14. cont…
• incision:
 lateral malleolus:
lateral approach
 medial malleolus:
anterior approach
a
b

15. cont…
stabilization with k- wire
fixed with screw and plate applying drain
wound closure

16. cont...
a b
c d

17. • range of motions: early group
a c
b d

18. • range of motion: delayed group
a c
b d

19. cont…
• post-operative management:
 immobilizations with below knee
posterior slab
 foot elevations
 injectable antibiotics 12 hourly for 48
hrs
 toe movement
 suture removal on the 10th day

20. cont…
• follow up:
 monthly opd check up for 1 year
 weight bearing: restricted for 6 weeks
 partial weight bearing: after 6 weeks
 full weight bearing.

21. results
0
5
10
15
20
25
30
35
40
early
group
delayed
group
37.00 37.00
• mean operating time (in mins):

22. cont…
0
2
4
6
8
10
12
14
early
group
delayed
group
6.6
13
• mean wound infections (in %):

23. cont…
0
2
4
6
8
10
early
group
delayed
group
6.2
9.4
• mean durations of hospital stay (in days):

24. cont…
7.2
7.3
7.4
7.5
7.6
7.7
7.8
7.9
8
8.1
early
group
delayed
group
7.47
8.00
• mean time for clinical union (in weeks):

25. cont…
11.2
11.4
11.6
11.8
12
12.2
12.4
12.6
12.8
13
13.2
early
group
dealyed
group
11.80
12.93
• mean time for radiological union (in weeks):

26. cont…
11.2
11.4
11.6
11.8
12
12.2
12.4
12.6
12.8
13
13.2
early
group
dealyed
group
11.80
12.93
• mean time for weight bearing (in weeks):

27. cont...
82
84
86
88
90
92
94
Early
group
Delayed
group
93.3
86.6
• range of motion of two groups
dorsiflexion ( in %)
20˚-30˚

28. cont...
82
84
86
88
90
92
94
early
group
delayed
group
93.3
86.6
• range of motion of two groups
plantar flexion ( in %)
40˚-50˚

29. cont...
76
78
80
82
84
86
88
0˚-30˚
early
group
delayed
group
80
86.6
• range of motion two groups:
pronation (in %)

30. cont...
76
78
80
82
84
86
88
o˚-60
early
group
delayed
group
80
86.6
• range of motion two groups:
supinations (in %)

31. cont…
60
20
13.3
6.6
53.3
20 20
6.6
excellent good fair poor
. functional outcome (in %):
early
group
delayed
group

32. discussions
• ankle is important weight bearing joint
• timely intervention
• early treatment advantageous
• minimal hospital expenditure
• short post-operative hospital stay
• lesser post operative infection early group

33. cont…
• delayed orif is alternative
• as no significant:
 operating time, radiological union
 weight bearing and functional outcome.
• limitation of study:
 small sample size and short follow-up.

34. conclusions
• early treatment is prefer to delayed:
 less wound infections and hospital stay
 Less medical expenses
• delayed treatment: reasonable options
 2/3rd shows excellent to good results in
both the groups.

35. Thank You