The impact of surgical timing in ankle fracture on postoperative wound complications: a critical 24-hour cutoff point through systematic review and meta-analysis

Abstract

Background: Ankle fractures are among the most prevalent injuries in the general population, and the timing of surgical fixation may influence postoperative wound complications. This systematic review and meta-analysis investigated the impact of surgical timing on postoperative wound complications, specifically investigating the significance of a 24-hour cutoff point.

Materials and methods: The comprehensive literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using PubMed, Embase, Web of Science, and Cochrane databases. Research evaluating and comparing clinical outcomes following ankle fracture treatment between early versus delayed surgical fixation groups, specifically using a 24-hour cutoff point, were reviewed. Evaluated data for the meta-analysis included total wound complications: divided into major and minor wound complications, length of stay, and other complications such as fixation failure.

Results: A total of eight studies were included in this systematic review and meta-analysis. In total, 1,183 patients were analyzed, with 572 in the early fixation group and 611 in the delayed fixation group. Compared to the delayed fixation group, the early fixation group significantly reduced total wound complications and length of stay, with a relative ratio of 0.37 (95% CI, 0.22 to 0.60) and - 0.88 (95% CI, -1.07 to -0.70), respectively. When analyzed as separate groups of major and minor wound complications, there was a trend showing lower rate of major and minor wound complication in the early fixation group than the delayed fixation group, but without reaching statistically significant differences.

Conclusions: Based on our review, early surgical intervention within the first 24 h may be considered to minimize the risk of postoperative wound complications and reduce the length of stay in ankle fractures.

Level of evidence: Level 3.

Keywords: 24 Hours; And length of stay; Ankle fracture; Delayed fixation; Early fixation; Postoperative wound complications; Surgical timing.