Delayed Internal Fixation of Distal Radius and Bimalleolar Ankle Fractures Does Not Increase Surgical Time

Aman Chopra, Paul Hoogervorst, Meir Marmor*
UCSF/ZSFG Orthopaedic Trauma Institute, UCSF Department of Orthopaedic Surgery, San Francisco, CA, U.S.A



It is commonly believed that delay in fracture fixation of more than two weeks results in increased Surgical Time (ST), due to scar and callus formation at the fracture site. Reducing ST can lower hospital costs and decrease radiation exposure.

Results & Methods:

A retrospective chart review was conducted to investigate whether early fracture care (up to 2 days after injury) results in decreased ST and radiation exposure compared to delayed fracture care (> 14 days after injury) for distal radius and bimalleolar ankle fractures. A total of 581 radius and ankle fractures that underwent surgical fixation between 2014 and 2017 were identified from the OR registry. Cases with only a single volar locking plate for the distal radius and constructs consisting of 2 medial malleolar screws, third tubular plate, and up to 1 syndesmotic screw for the ankle were included. The mean ST for distal radius cases done up to 2 days after injury was significantly greater than ST for distal radius cases done > 14 days after injury (125.78±29.75 minutes versus 105.83±24.82 minutes respectively , p=0.06). The mean ST for ankle fracture cases done less than 2 days did not differ from ST for ankle fracture cases done > 14 days after injury (140.86±28.15 minutes versus 173.22±39.98 minutes respectively , p=0.06).


There was no significant difference in radiation exposure. Delaying surgery for distal radius and bimalleolar ankle fractures > 14 days after injury does not seem to significantly affect the duration of surgery or radiation exposure.

Keywords: Fracture, Delaying surgery, Bimalleolar ankle fractures, Surgical Time (ST), Malleolar screws, Distal radius.

Abstract Information

Identifiers and Pagination:

Year: 2019
Volume: 13
Publisher Item Identifier: EA-TOORTHJ-2018-70

Article History:

Received Date: 15/03/2018
Revision Received Date: 28/09/2018
Acceptance Date: 16/01/2019
Electronic publication date: 07/02/2019
Collection year: 2019

© 2019 Chopra et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Correspondence: Address correspondence to this author at the UCSF Department of Orthopaedic Surgery, 2550 23rd street, Building 9, 2nd floor, Orthopaedic Trauma Institute, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA 94110, USA; Tel: (650) 477-6238; E-mail: