Impact of Delayed Reduction on Soft Tissue Compromise and Clinical Outcomes in Displaced Ankle Fractures.

BACKGROUND: Ankle fractures are a common traumatic injury, often resulting in displaced anatomic alignment. Delayed treatment can prevent adequate soft tissue resuscitation, causing significant complications. PURPOSE: We evaluated time to reduction impact on soft tissue compromise and post-operative outcomes, including rate of complications, re-operation, and length of hospital stay. STUDY DESIGN: We retrospectively reviewed individuals with displaced ankle fractures that underwent closed reduction in the emergency department or in the operating room from January 1, 2022 through December 31, 2025. PATIENTS AND METHODS: Multivariable logistic regression was performed to analyze time to reduction impact on key outcomes. We also evaluated associations with age, body mass index, gender, social history (smoking), and comorbidities (diabetes, renal disease, peripheral vascular disease). RESULTS: Our study included 147 patients. Delayed time to ankle reduction was associated with increased odds of pre-operative soft tissue compromise (odds ratio 1.601, 95% confidence interval 1.101-2.407, p = 0.017) but not independently associated with post-operative complications, re-operation, or hospital length of stay. Peripheral vascular disease and renal disease demonstrated stronger associations with adverse post-operative outcomes (p = 0.027 and p = 0.014). Soft tissue compromise and advancing age noted to be associated with longer hospital stays (both p < 0.001). CONCLUSION: Delayed time to ankle reduction increased the odds of pre-operative soft tissue compromise but was not independently predictive of post-operative complications, re-operation, or length of stay. These findings demonstrate the importance of prioritizing timely reduction for these displaced ankle traumas to optimize preservation of the soft tissue envelope. LEVEL OF CLINICAL EVIDENCE: 3.