Impact of pre-surgical reduction methods on soft tissue healing and surgical timing in ankle fractures

TL;DR

This study compares two methods for managing ankle fractures before surgery, finding that one method may lead to faster surgical timing but requires hospitalization.

Contribution

The study provides preliminary evidence on the impact of Quigley’s skin traction versus U-splinting on surgical timing for ankle fractures.

Findings

Quigley’s skin traction was associated with a significantly shorter time to surgery compared to U-splinting.

Bayesian analysis confirmed the shorter time to surgery with Quigley’s technique.

Hospitalization for traction introduces bias and must be weighed against benefits.

Abstract

Early closed reduction and immobilization are essential in managing unstable ankle fractures to mitigate soft tissue swelling prior to surgery. This retrospective, single-center, preliminary study compares the effect of two reduction maintenance techniques, plaster U-splinting and Quigley’s skin traction suspension, on time to surgery.

A retrospective observational review was conducted on 54 patients (aged 18–65) with unstable ankle fractures (Weber B/C). Surgical timing served as the dependent variable; reduction technique and patient variables were independent variables. Both Bayesian estimation and frequentist methods, including t tests and correlation analyses, were employed.

Patients treated with Quigley’s skin traction experienced shorter median times to surgery (5.3 days, SD = 2.8) compared to the U-splint group (10.7 days, SD = 3.9). This difference was statistically significant (p < 0.001). Bayesian analysis (posterior mean difference: 5.4 days, 95% CrI: 3.2–7.5; Bayes Factor = 12.6) supported these findings. However, patients in traction were hospitalized throughout, introducing inherent bias.

Preliminary findings suggest that the inpatient use of Quigley’s technique, likely through continuous elevation and regular monitoring, was associated with shorter time to surgery, though causality cannot be established due to confounding. This advantage must be weighed against the costs of hospitalization and potential complications. More extensive, prospective studies with standardized follow-up and complication reporting are needed.

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