Is early operative fixation of unstable ankle fractures cost effective? Comparison of the cost of early versus late surgery

  • Dimitrios ManoukianEmail author
  • Dimitra Leivadiotou
  • William Williams
Original Article



A retrospective study of all patients who sustained an ankle fracture requiring operative treatment was performed. 98 patients were admitted over a 14-month time period. All fractures treated conservatively were excluded.

Materials and methods

The inpatient length of stay and the cost of operating less than and more than 24 and 48 h from admission was determined.


There was a significant difference (p value <0.001) in cost and length of stay in patients operated less than and more than 24 h, and less than and more than 48 h from admission. There was no difference in cost and length of stay between the 2 groups of less than 24 and 48 h. However, length of stay and cost rose significantly if the operation was delayed more than 48 h.


The results show that the length of stay and cost is significantly reduced by operating on ankle fractures early. There is no significant difference in the length of stay or cost if the operation is performed earlier than 24 or 48 h from admission.


Ankle injuries Cost effectiveness Comparison Pre-operative period 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Ashley Murray M, Sinead McDonald E, Archbold P, Grainne Crealey E (2011) Cost description of inpatient treatment for ankle fracture. Injury Int J Care Injured 42:1226–1229CrossRefGoogle Scholar
  2. 2.
    Breederveld RS, van Straaten J, Patka P, van Mourik JC (1988) Immediate or delayed operative treatment of fractures of the ankle. Injury 19:436–438PubMedCrossRefGoogle Scholar
  3. 3.
    Caschman J, Blagg S, Bishay M (2004) The efficacy of the A-V impulse system in the treatment of posttraumatic swelling following ankle fracture: a prospective randomized controlled study. J Orthop Trauma 18(9):596–601PubMedCrossRefGoogle Scholar
  4. 4.
    Department of Health (2008) NHS reference costs 2006–07. Department of Health, LondonGoogle Scholar
  5. 5.
    Høiness P, Engebretsen L, Strømsøe K (2002) Cost of surgical treatment of closed ankle fractures. Eur J Trauma 28:258–262CrossRefGoogle Scholar
  6. 6.
    Høiness P, Engebretsen L, Strømsøe K (2003) Soft tissue problems in ankle fractures treated surgically. A prospective study of 154 consecutive closed ankle fractures. Injury 34(12):928–931PubMedCrossRefGoogle Scholar
  7. 7.
    James LA, Sookhan N, Subar D (2001) Timing of operative intervention in the management of acutely fractured ankles and the cost implications. Injury 32:469–472PubMedCrossRefGoogle Scholar
  8. 8.
    John M, Lloyd RachelMartin, Rajagopolan S, Zieneh N, Hartley R (2010) An innovative and cost-effective way of managing ankle fractures prior to surgery—home therapy. Ann R Coll Surg Engl 92:615–618CrossRefGoogle Scholar
  9. 9.
    Konrath G, Karges D, Watson JT, Moed BR, Cramer K (1995) Early versus delayed treatment of severe ankle fractures: a comparison of results. J Orthop Trauma 9:377–380PubMedCrossRefGoogle Scholar
  10. 10.
    Pietzik P, Qureshi I, Langdon J et al (2006) Cost benefit with early operative fixation of unstable ankle fractures. Ann R Coll Surg Engl 88:405–407PubMedCrossRefGoogle Scholar
  11. 11.
    Westacott DJ, Abosala AA, Kurdy NM (2010) The factors associated with prolonged inpatient stay after surgical fixation of acute ankle fractures. J Foot Ankle Surg 49(3):259–262PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Dimitrios Manoukian
    • 1
    Email author
  • Dimitra Leivadiotou
    • 1
  • William Williams
    • 1
  1. 1.Department of Trauma and OrthopaedicsBroomfield Hospital Mid Essex NHS TrustChelmsfordUK

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