Jain Nitin, Symes Tom, Doorgakant Ashtin, Dawson Matt
Department of Emergency Medicine, North Tees and Hartlepool NHS Trust, Stockton on Tees, Cleveland, UK.
Ann R Coll Surg Engl. 2008 Sep;90(6):483-7. doi: 10.1308/003588408X301145.
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.
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.
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 pounds to 129.80 pounds.
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.
踝关节骨折很常见，其中“稳定型”踝关节骨折占该类骨折的40% - 75%。研究表明，这些损伤采用功能性支具即可成功治疗，无需进一步的X光检查，门诊随访也极少。我们旨在审查当前的治疗方法并做出改变，以改善治疗效果并节省费用。
进行了一项为期6个月的回顾性审查以确定现有治疗方法。随后制定了指南并在急诊科和骨科广泛分发。这些指南包括稳定型踝关节骨折的诊断标准、使用支具治疗此类损伤的管理方案以及门诊随访流程。接着进行了一项为期6个月的前瞻性审查，以评估这些指南的有效性。
在第二个6个月期间就诊的患者中，91%采用功能性支具治疗。指南实施后，门诊随访预约的平均次数、出院前的周数以及复查X光片的次数均显著减少（P < 0.05）。治疗一名稳定型踝关节骨折患者的费用从310.75英镑降至129.80英镑。
先前的研究表明，稳定型踝关节骨折采用功能性支具治疗比石膏固定更有效，不会发生移位，因此无需复查X光片。之前的一项审查表明，60%的稳定型骨折患者可以使用支具治疗。我们已经证明，通过对同事进行有效且持续的培训，绝大多数（91%）患者可以采用这种方式治疗，这带来了显著的费用节省。我们还证明，基于证据的治疗方案可以显著改善患者的治疗效果，并为医疗机构节省费用。
