A prospective study of 493 Ankle Fractures in a UK trauma unit: What lessons can be learnt?

H.H. Chong, M. Burgula, K. Kutwayo, P. Rai, M. Hau, R. Faroug, J. Mangwani

Introduction: Ankle fractures represent 10% of the fracture workload and are projected to increase due to ageing population. We present our experience and lessons learnt in the management of ankle fractures in a large UK Trauma unit.

Methods: Prospective data collected between 2013 and 2017 was retrospectively analysed. A total of 493 patients entered into the database were divided into Stable ankle fractures (Group A) and unstable ankle fractures treated with surgical fixation (Group B).
Petronne's criteria were used to assess quality of reduction in Group B. Pre and post injury PROMs were compared using Olerud-Molander Ankle Scores (OMAS) and Lower Extremity Functional Scales (LEFS).

Results: In Group A, 132 patients matched the criteria for the “stable ankle pathway ” and were allowed weight bearing in a cast or boot. Two patients required surgery due to talar shift on weight bearing x-rays at one week and two patients had delayed union.
In Group B, of 351, data was available for 302 patients for final analysis. The mean age was 46.7, with comorbidities 186 (72.1%) overweight, 14 (4.7%)cdiabetes, 65 (23%) smokers, 33 (11.6%) alcoholics and 1 steroid use. Seventy-three (34%) had inadequate reduction in 2014-2015; this figure reduced to 12 cases, 13.8% in 2016-17, after introduction of a simple educational tool. There were 8 (3.1%) post-operative wound infections. Pre- and post-op OMAS and LEFS were compared which showed mean reduction of 14.7 and 11.3 respectively. Multiple regression analysis did not reveal any significant co-relation between patient demographics, co-morbidities, radiological outcomes and post-op PROMS.

Conclusion: Our 'stable ankle pathway' is safe and effective. We recommend a simple educational tool to improve trainees and general trauma surgeon's awareness in treating this injury adequately. Patients should be counselled for general decline in ankle function due to the injury regardless of adequate fixation.