Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, Room H-822k, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Int Orthop. 2013 Mar;37(3):489-94. doi: 10.1007/s00264-012-1753-9. Epub 2013 Jan 4.
Information about the influence of delayed surgery on infectious wound complications is ambiguous. A clinical audit was performed to test the hypothesis that early surgery lowers the rate of infectious wound complications. Secondly we looked at the influence of surgical delay and complications on patient reported functional outcome.
All consecutive, closed distal fibular fractures treated surgically with a plate were included and retrospectively analysed for the delay in operation and wound complications. In a second cohort of patients with a AO-Weber B-type ankle fracture outcome was measured using the Olerud-Molander ankle score (OMAS), the American Orthopaedic Foot and Ankle Society score (AOFAS) and a visual analog score (VAS) for overall satisfaction.
Patients treated within one day experienced no wound complications (zero out of 60), whereas in the delayed group 11% (16/145) did (p = 0.004). A similar significant difference was found for the patients treated within one week (2/98) versus after one week (14/107). A systematic review of the literature showed a difference in wound complications of 3.6% (early) versus 12.9% (late) (p < 0.0001). After 43 months, the median AOFAS was 11.5 points lower in the complication group, the OMAS 10 points, and the VAS 0.5 points, with all differences being statistically significant.
Every effort should be made to operate on closed ankle fractures as soon as reasonably possible. A delay in surgery is associated with a significant rise in infectious wound complications, which significantly lowers outcome and patient satisfaction. These fractures should preferably be treated within the first day.
关于手术延迟对感染性伤口并发症影响的信息尚不清楚。进行了一项临床审核，以检验手术尽早进行可降低感染性伤口并发症发生率的假设。其次，我们研究了手术延迟和并发症对患者报告的功能结果的影响。
所有连续的、闭合的腓骨远端骨折患者均接受钢板内固定治疗，对手术延迟和伤口并发症进行回顾性分析。在第二组接受 AO-Weber B 型踝关节骨折治疗的患者中，使用 Olerud-Molander 踝关节评分（OMAS）、美国矫形足踝协会评分（AOFAS）和总体满意度视觉模拟评分（VAS）来测量结果。
在一天内接受治疗的患者没有出现伤口并发症（60 例中无 0 例），而延迟组中 11%（145 例中有 16 例）（p=0.004）。在一周内接受治疗的患者（2/98）与一周后接受治疗的患者（14/107）之间也发现了类似的显著差异。对文献的系统回顾显示，伤口并发症的差异为 3.6%（早期）与 12.9%（晚期）（p<0.0001）。在 43 个月时，并发症组的 AOFAS 中位数低 11.5 分，OMAS 低 10 分，VAS 低 0.5 分，所有差异均具有统计学意义。
应尽一切努力尽快对闭合性踝关节骨折进行手术。手术延迟与感染性伤口并发症的显著增加相关，这显著降低了结果和患者满意度。这些骨折最好在第一天内进行治疗。
