O2107: Socioeconomic Factors and Their Impact on Time to Surgery and Complications in Pediatric Ankle Fractures

Background: Among older children, ankle fractures stand out as one of the most common lower extremity injuries, contributing to up to 40% of all fractures in this age group, primarily attributed to sports-related incidents or high-energy trauma. While the timing from injury to surgery has been investigated in adults who underwent ankle open reduction and internal fixation (ORIF), the factors influencing delayed surgery (> 14 days) and its effects remain uncertain in children. This study aims to investigate the effects of socioeconomic factors on the timing of ankle ORIF and the subsequent complications in pediatric patients.

Methods: One hundred and fourteen pediatric patients ( < 18 years) who underwent ankle ORIF between 2016 and 2022 at a single academic tertiary care center were identified in a retrospective review and 93 met our inclusion criteria. Demographic and clinical characteristics collected included insurance type (public or private), Child Opportunity Index 2.0 (COI), infection, hardware failure, hardware removal, revision surgery, post-operative range of motion, and Visual Analogue Scale (VAS) pain scores. Patients were categorized into two cohorts based on the time between injury and surgery: < 14 days (early) and >14 days (delayed).

Results: The mean time to surgery for those in the “early” (n=75) and “delayed” (n=18) cohort were 8.23 and 22.00 days, respectively. There were no significant differences between demographic characteristics, including insurance type and COI, complications, or range of motion, and VAS pain scores at 3 months and 6 months post-op, among the cohorts.

Conclusion: Insurance type and COI were not significantly associated with surgery delayed beyond 14 days after injury. Moreover, postponing ankle ORIF by more than 14 days did not significantly increase infection rates, hardware failure, hardware removal, revision surgery, postoperative range of motion, or VAS pain scores. These findings suggest that there may be greater flexibility in managing pediatric ankle fractures regarding the timing of surgery.