Wash out, splint/ex-fix and do electively Mani Kahn MD
No disclosures
Zura rushing to definitively fix an ankle in the middle of the night….
Can we really trust his judgement?
Hollywood elite! NCIS New Orleans, 2017
Open ankle fractures • 5% incidence • Higher energy injuries
Well accepted dogma… “Delayed ORIF is an acceptable alternative when soft-tissue swelling, fracture blisters, or abrasions are present that offer an undesirable environment for surgical incisions.” -Konrath et al 1995
Obstacles to early definitive treatment • Multiply injured and under-resuscitated patients • Protracted transport times • OR availability • Suboptimal conditions • Trauma surgeon availability
Role of fatigue in medical errors • Potential for compromised technical or cognitive performance Williamson et al. 2000
Risk factors for infection in open fracture… • Increasing Gustilo grade • Lower extremity fractures Harley et al 2002
Open Ankle Fracture Complication Rates • Deep infection 8% • Skin Necrosis 14% Hulsker 2011
In Series’ with Immediate ORIF… Wiss et al 1988 Joshi et al 2006 • 5% infection • 20% complication rate – Skin necrosis • 8% late arthrodesis – Loss of reduction • Longer hospital stays for early ORIF
23 F acro-yoga injury
Closed “reduction”
External fixation, percutaneous pinning
POD#10: Elective ROH, ORIF
2 weeks postop
3 months postop
6 months postop
Thank You
Bibliography Konrath et al. Early Versus Delayed Treatment of Severe Ankle • Fractures: A Comparison of Results. Journal of Orthopaedic Trauma. 9(5):377-380, October 1995. Hulsker et al. Evidence-based treatment of open ankle fractures. • Arch Orthop Trauma Surg (2011) 131:1545–1553 Wiss et al. Immediate Internal Fixation of Open Ankle Fractures. • Journal of Orthopaedic Trauma. 2(4):265-271, 1988. Joshi et al. Immediate open reduction and internal fixation in open • ankle fractures. J Am Podiatr Med Assoc. 2006 Mar-Apr;96(2):120- 4. Williamson AM, Feyer AM: Moderate sleep deprivation produces • impairments in cognitive and motor performance equivalent to legally pre- scribed levels of alcohol intoxication. Occup Environ Med 2000;57:649- 655.
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