Ankle fractures are common injuries in adults, representing more than half of all fractures of the foot and ankle seen at major trauma centers in the United States. Over the last 50 years, there has been an increase in the incidence and severity of ankle fractures. These fractures are commonly due to twisting injuries, and occur more often in sports and in the elderly.
Nonemergency fractures are the majority of fractures. Emergency situations include fractures in which the skin has opened (formerly termed compound fractures) or cases in which the ankle is dislocated or subluxated (the joint itself is significantly out of place, putting the articular cartilage at risk of further damage), or when there are other associated injuries which may cause skin tenting. A substantial proportion of these injuries require open reduction and internal fixation.
Inpatient vs Outpatient Surgical Treatment: Which Is Best?
There is some debate on whether inpatient vs outpatient surgical treatment is best to treat non-emergency ankle fractures. By avoiding inpatient surgery and opting for outpatient surgery unnecessary hospitalizations can be minimized. Dr. Dominic Carreira performs ankle arthroscopy in higher energy ankle fractures to treat these potential articular cartilage injuries to optimize surgical outcomes.
A recent study conducted at the Northwestern University Feinberg School of Medicine in Chicago, Illinois compared inpatient and outpatient open reduction internal fixation (ORIF) for non-emergency ankle fractures. The study found that outpatient surgery was associated with reduced risk of morbidities 30 days after surgery and no difference in complications during surgery, re-operations, or readmissions.
These results suggest that immediate treatment of non-emergency ankle fractures is not necessary, and outpatient care is comparable or better than inpatient hospitalization. After appropriately immobilizing the ankle, patients can return home and elevate the extremity to reduce swelling prior to surgical treatment.
Read more here: http://jbjs.org/content/98/20/1699