Ankle Fracture Surgery: Is Swelling a Real Barrier?

Surgeons often delay ankle fracture surgeries due to swelling, fearing it increases wound complications. However, there are no guidelines or validated measures that dictate timing.

A Level II prospective cohort study, Preoperative Ankle Swelling and the Effect on Postoperative Wound Complications Following Ankle Fracture Surgery, examined whether preoperative swelling correlates with postoperative wound issues.

The study involved: 

• 80 patients with closed, unilateral rotational ankle fractures

• Swelling assessed visually and with the figure-of-8 technique (objective)

• Follow-up at two, six, and 12 weeks

• Surgeons chose surgery timing per usual practice

Key findings include:

• Wound complication rate of 8.75% (with one deep infection).

• No significant link found between wound complications and visual swelling (P = .65), measured swelling (P = .76), or time to surgery (P = .27)

• Higher complication rates were tied to increased age (P = .006) and female gender (P = .034)

• BMI, surgeon experience, and tourniquet time were not found to be significant factors in this study

• Only moderate agreement between visual and measured swelling (ICC = 0.507)

Bottom line

Delaying surgery solely due to residual swelling may not reduce wound complications. Visual swelling assessment alone isn’t reliable, and carefully selected early interventions may be safe.