University Hospital Coventry and Warwickshire, UK.
Foot Ankle Surg. 2013 Dec;19(4):250-4. doi: 10.1016/j.fas.2013.06.014. Epub 2013 Aug 6.
Ankle fractures requiring operative fixation often swell up after 24h and surgery during this period is not feasible as there are several associated risks including infection and wound breakdown. The affected limb is kept elevated usually in hospital and once the swelling has sufficiently subsided then the operation takes place. We conducted a study looking at the impact of a home therapy ankle pathway on the length of stay and safety of patients with ankle fractures requiring surgical fixation.
The length of stay of a control group was studied from December 2009 to March 2010. The home therapy ankle pathway was then introduced in August 2010. If patients could not have their operation within 24h then they were placed in a Plaster of Paris back slab in casualty with the ankle reduced, limb care advice given - elevation, cooling and DVT thromboprophylaxis - and the patient was discharged home on crutches after a slot was determined on the trauma list typically six days later. The patient was also given an emergency contact number in case an untoward event occurred, and they were called at least once during their home stay by hospital staff to ensure all was well. Patients who were unsafe to be discharged on home therapy were admitted. This cohort of patients was studied between August 2010 and December 2011 RESULTS: In the control group, 49 ankle fractures required operative intervention. The mean pre-operative length of stay was 2.88 days and the mean post op length of stay was 5 days. Between August 2010 and December 2011, after implementation of the pathway, 176 ankle fractures requiring operative treatment presented to the orthopaedic department. Of these, 105 were eligible for home therapy on the ankle pathway prior to surgery. The average pre-operative length of stay on the pathway was 0.17 days. The average post op length of stay was 1.72 days (P<0.001 in all modalities). Home therapy was carried out for an average of 6.63 days. Challenges of home therapy included persistent swelling and blistering (11), loss of reduction (4), poor pain management whilst at home (4) and cancellation due to lack of availability of a theatre slot (6).
With patients in whom it is indicated, the home therapy ankle pathway has proved to be a safe and resource sparing method of managing ankle fractures prior to surgery.
需要手术固定的踝关节骨折通常在 24 小时后肿胀，在此期间手术不可行，因为存在多种相关风险，包括感染和伤口破裂。受影响的肢体通常在医院抬高，一旦肿胀充分消退，手术即可进行。我们进行了一项研究，探讨了踝关节家庭治疗途径对需要手术固定的踝关节骨折患者的住院时间和安全性的影响。
研究了对照组 2009 年 12 月至 2010 年 3 月的住院时间。然后，在 2010 年 8 月引入了踝关节家庭治疗途径。如果患者在 24 小时内不能进行手术，则将其放置在急诊室的石膏背夹板中，将踝关节复位，给予肢体护理建议 - 抬高、冷却和 DVT 血栓预防 - 并在创伤名单上确定插槽后，患者用拐杖出院，通常在六天后。患者还获得了紧急联系号码，以防发生意外事件，并且在他们在家期间，医院工作人员至少会打一次电话，以确保一切正常。不安全出院的患者入院。在 2010 年 8 月至 2011 年 12 月期间研究了这组患者。
在对照组中，49 例踝关节骨折需要手术干预。术前平均住院时间为 2.88 天，术后平均住院时间为 5 天。在 2010 年 8 月至 2011 年 12 月期间，在实施途径后，176 例需要手术治疗的踝关节骨折到骨科就诊。其中，105 例在术前符合踝关节途径家庭治疗条件。途径上的术前平均住院时间为 0.17 天。术后平均住院时间为 1.72 天（所有方式均 P<0.001）。家庭治疗平均进行了 6.63 天。家庭治疗的挑战包括持续肿胀和水疱（11）、复位丢失（4）、在家中疼痛管理不佳（4）和由于缺乏手术插槽而取消（6）。
对于适合的患者，踝关节家庭治疗途径已被证明是一种安全且资源节约的方法，可以在手术前治疗踝关节骨折。
