THE IMPORTANCE OF TIMING OF SURGERY IN CLOSED ANKLE FRACTURE – A LITERATURE REVIEW

Background:Ankle fractures are the second most common lower limb injury and remain a challenge for healthcare professionals due to minimal soft tissue coverage and the high potential for significant swelling. This swelling can compromise terminal vasculature in the superficial layers, reducing the tissue’s reparative capacity. In closed ankle fractures, determining the appropriate timing of surgery for displaced fractures is crucial. Operating too soon increases the risk of wound healing complications, whereas delaying too long may hinder optimal anatomical reduction. Current recommendations, such as the AO/ASIF guidelines, suggest surgery within 6–8 hours of injury or delaying for 4–6
days in cases with significant edema or fracture blisters. However, these guidelines are largely based on expert opinion, and there is no definitive consensus on the optimal timing.
Objectives:To evaluate the optimal timing of surgery for closed ankle fractures and its impact on postoperative outcomes, including wound healing, systemic complications, and long-term ankle function.
Results:Existing literature indicates that both early and delayed surgeries carry risks. Early intervention may increase wound-related complications, while excessive delay may impair anatomical reduction and functional outcomes. No universally accepted cut-off point between early and delayed surgery has been established, and most evidence is based on small-scale or observational studies.
Conclusion:Determining the ideal timing for surgical intervention in closed ankle fractures is critical for minimizing complications and optimizing outcomes. High-quality, large-scale studies are needed to establish evidence-based guidelines that clearly define the threshold between early and delayed surgery.