Authors: Jain, Nitin¹; Symes, Tom²; Doorgakant, Ashtin³; Dawson, Matt⁴

Source: Annals of The Royal College of Surgeons of England, Volume 90, Number 6, September 2008 , pp. 483-487(5)

Publisher: The Royal College of Surgeons of England

Abstract:

INTRODUCTION: Ankle fractures are common and 'stable' ankle fractures comprise 40-75% of this group. Studies show that these injuries can be managed successfully in a functional brace, with no need for further radiographs and minimal out-patient follow-up. We aimed to audit current practice and introduce change in order to improve treatment and produce financial savings.

PATIENTS AND METHODS: A retrospective 6-month audit was carried out to establish practice. Guidelines were then drawn up and widely distributed in the accident and emergency (A&E) and orthopaedic departments. These included criteria for diagnosis of stable ankle fractures, a management protocol for treatment of these injuries in a brace and also a follow-up algorithm in the out-patient clinic. A prospective 6-month audit was then carried out to assess the effectiveness of the guidelines.

RESULTS: Of patients presenting in the second 6-month period, 91% were managed in a functional brace. The mean number of out-patient follow-up appointments, weeks until discharge and repeat radiographs all decreased significantly (P < 0.05) after the implementation of the guidelines. The cost of treating a patient with a stable ankle fracture dropped from £310.75 to £129.80.

CONCLUSIONS: Previous studies have shown that stable ankle fractures are more effectively treated in a functional brace than a plaster cast, do not displace and, therefore, do not need repeat radiographs. A previous audit demonstrated that 60% of patients with stable fractures could be treated in a brace. We have shown that, with effective and persistent education of colleagues, the vast majority (91%) of patients can be managed in this way and this results in a significant cost saving. We have also shown that an evidence-based treatment protocol can produce significant improvements in management for patients and savings for healthcare organisations.

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Keywords: ANKLE; FRACTURE; MEDICAL AUDIT; EVIDENCE-BASED MEDICINE

Document Type: Research article

DOI: http://dx.doi.org/10.1308/003588408X301145

Affiliations: 1: Department of Emergency Medicine, North Tees and Hartlepool NHS Trust, Stockton on Tees, Cleveland, UK 2: Department of Trauma and Orthopaedics, North Tyneside General Hospital, North Shields, Tyne and Wear, UK 3: Department of Trauma and Orthopaedics, Sunderland Royal Infirmary, Sunderland, UK 4: Department of Orthopaedics, Cumberland Infirmary, Carlisle, UK

Publication date: 2008-09-01

More about this publication?

• The Annals of The Royal College of Surgeons of England is the official journal of the College and is published eight times a year in January, March, April, May, July, September, October and November. The main aim of the journal is to publish high quality, peer-reviewed papers that relate to all branches of surgery.
  
  The Annals also includes letters and comments, a regular technical section, NICE news, controversial topics, CORESS feedback, book reviews and the best trainee presentations from England and Wales. The editorial board is composed of members of the College Council and experts from across the surgical specialties.
  
  Archive issues of the Annals of The Royal College of Surgeons of England are available via the PubMed Central database
  
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