Weight-bearing in ankle fractures: An audit of UK practice |
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| Institution: | 1. Podiatry Department, University Hospital, 150 Bergen Street, Room G-142, Newark, NJ 07103, USA;2. Podiatric Medicine and Surgery Residency Program, University Hospital, 150 Bergen Street, Room G-142, Newark, NJ 07103, USA;3. Department of Medicine, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103, USA;4. Department of Psychiatry, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103, USA;1. Trauma and Orthopaedic Department, Aintree University Hospital, Lower Lane, Liverpool L9 7AL, UK;2. Mersey Ortho-plastic Group, Liverpool Limb Reconstruction Service;3. University of Liverpool, Liverpool, UK;1. Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Jena, Germany;2. Department of Trauma, Hand and Reconstructive Surgery, HELIOS Clinical Centre, Erfurt, Germany;3. Department of Trauma and Reconstructive Surgery, BG Centres Bergmannstrost, Halle, Germany;4. Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Germany;5. Department of Foot and Ankle Surgery, St. Vincenz and Elisabeth Hospital, Mainz, Germany;1. Foot and Ankle Surgery, UCLA Harbor Medical Center, 1000 W. Carson Street, Torrance, CA 90502, USA;2. Foot and Ankle Department, Congress Medical Associates, 800 South Raymond, 2nd Floor, Pasadena, CA 91105, USA;1. Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea;2. Department of Anesthesiology and Pain Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea |
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| Abstract: | IntroductionThe purpose of this national study was to audit the weight-bearing practice of orthopaedic services in the National Health Service (NHS) in the treatment of operatively and non-operatively treated ankle fractures.MethodsA multicentre prospective two-week audit of all adult ankle fractures was conducted between July 3rd 2017 and July 17th 2017. Fractures were classified using the AO/OTA classification. Fractures fixed with syndesmosis screws or unstable fractures (>1 malleolus fractured or talar shift present) treated conservatively were excluded. No outcome data were collected. In line with NICE (The National Institute for Health and Care Excellence) criteria, “early” weight-bearing was defined as unrestricted weight-bearing on the affected leg within 3 weeks of injury or surgery and “delayed” weight-bearing as unrestricted weight-bearing permitted after 3 weeks.Results251 collaborators from 81 NHS hospitals collected data: 531 patients were managed non-operatively and 276 operatively. The mean age was 52.6 years and 50.5 respectively. 81% of non-operatively managed patients were instructed for early weight-bearing as recommended by NICE. In contrast, only 21% of operatively managed patients were instructed for early weight-bearing.DiscussionThe majority of patients with uni-malleolar ankle fractures which are managed non-operatively are treated in accordance with NICE guidance. There is notable variability amongst and within NHS hospitals in the weight-bearing instructions given to patients with operatively managed ankle fractures.ConclusionThis study demonstrates community equipoise and suggests that the randomized study to determine the most effective strategy for postoperative weight-bearing in ankle fractures described in the NICE research recommendation is feasible. |
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| Keywords: | Fractures Ankle Weight-bearing Early Delayed NICE |
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