Cost benefit with early operative fixation of unstable ankle fractures.

Abstract

INTRODUCTION:

Ankle fractures are common and many require surgical intervention. It has been well documented that a delay in fracture fixation results in increased length of hospital stay and increased complication rate. Initial delay can also allow swelling or blistering to develop which may necessitate a further delay in operative fixation for up to 1 week. The aim of the current study was to review the length of hospital in-patient stay for operative ankle fractures over the previous 12-month period at our hospital and compare this to the length of hospital stay following the introduction of a fast-track system for the fixation of these fractures (all fractures fixed within 48 h).

PATIENTS AND METHODS:

A retrospective review of all ankle fractures managed by open reduction and internal fixation over a 12-month period was undertaken. A protocol was then agreed to openly reduce and fix these fractures at the earliest possible opportunity over the next 6-month period. We then collected the data on all ankle fractures that needed open reduction and internal fixation over this 6-month period. The pre-protocol and post-protocol groups were then compared for total hospital length of stay and complication rate.

RESULTS:

In the 12-month retrospective review, there were 83 ankle fractures that required surgical intervention. Sixty-two of these had surgery within 48 h (mean length of stay, 5.4 days), and 21 had surgery after 48 h (mean length of stay, 9.5 days). There were 39 ankle fractures in the post-protocol group who all had surgery within 48 h (mean length of stay, 5 days). There was no increase in complication rate after implementation of the fast-track system.

CONCLUSIONS:

This study shows that early operative intervention for ankle fractures reduces the length of hospital stay. Intensive physiotherapy and co-ordinated discharge planning are also essential ingredients for early discharge. Early operative fixation for unstable ankle fractures has substantial cost-saving implications with no increase in complication rate.

• Authors: P Pietzik, I Qureshi, J Langdon, S Molloy, M Solan
• Journal: Annals of the Royal College of Surgeons of England (Ann R Coll Surg Engl) Vol. 88 Issue 4 Pg. 405-7 (Jul 2006) ISSN: 1478-7083 [Electronic] England
• PMID: 16834865 (Publication Type: Journal Article)

Topics

• Adult
• Ankle Injuries (economics, surgery)
• Cost-Benefit Analysis
• Female
• Fracture Fixation (economics)
• Fractures, Bone (economics, surgery)
• Humans
• Length of Stay
• Male
• Medical Audit
• Patient Satisfaction
• Retrospective Studies