Gokhale Sandeep, D'sa Prashanth, Agarwal Rishi, Clutton Juliet, Roy Kunal, Carpenter Eleanor Clare, Mohanty Khitish, Hodgson Paul
Trauma and Orthopedics, University Hospital of Wales, Cardiff, GBR.
Trauma and Orthopedics, Wrexham Maelor Hospital, Wrexham, GBR.
Cureus. 2021 Nov 5;13(11):e19269. doi: 10.7759/cureus.19269. eCollection 2021 Nov.
Aim The purpose of this all Wales national audit was to compare compliance against British Orthopedic Association Standards for Trauma (BOAST) guidelines on the management of ankle fractures. Methods A multi-center prospective audit of the management of adult ankle fractures was conducted between February 2, 2020, and February 17, 2020, via the Welsh Orthopedic Research Collaborative (WORC). Regional leads were recruited in nine NHS hospitals across six university health boards, and recruited collaborators in their respective hospitals. Questionnaires for the data collection on both surgical and conservative management were made available via a password-protected website (walesortho.co.uk). We defined early weight-bearing (EWB) as unrestricted weight-bearing on the affected leg within three weeks of injury or surgery and delayed weight-bearing (DWB) as unrestricted weight-bearing after three weeks of injury or surgery. Results A total of 28 collaborators contributed data for 238 ankle fractures. Poor documentation at the time of injury was noted. Less than 50% of patients with posterior malleolus fracture had a CT scan for further evaluation. Eighty-four percent of the non-operatively treated patients did not have a weight-bearing X-ray (WBXR). Patients who had a WBXR were more likely to be allowed EWB but this was not statistically significant. EWB was allowed in 59.43% and 10% of the non-operatively and operatively treated patients, respectively. DWB was higher in patients who had fixation of the posterior malleolus or syndesmosis. Conclusion There is poor compliance with BOAST guidelines on the management of ankle fractures across Wales. We need to improve documentation and also consider performing a CT scan when the posterior malleolus is fractured. A weight-bearing X-ray should be performed more often to ascertain the stability of an ankle fracture, and those that are deemed stable should be treated with early weight-bearing. The guidelines need to be clearer regarding weight-bearing after fixation especially when posterior malleolus and/or syndesmosis are fixed.
目的 这项全威尔士范围的国家审计旨在比较踝关节骨折治疗在遵循英国矫形外科协会创伤标准（BOAST）指南方面的情况。方法 2020年2月2日至2020年2月17日期间，通过威尔士矫形研究协作组织（WORC）对成人踝关节骨折治疗进行了多中心前瞻性审计。在六个大学健康委员会的九家国民保健服务医院招募了地区负责人，并在各自医院招募了协作人员。通过一个受密码保护的网站（walesortho.co.uk）提供用于手术和保守治疗数据收集的问卷。我们将早期负重（EWB）定义为受伤或手术后三周内患侧下肢无限制负重，延迟负重（DWB）定义为受伤或手术后三周后无限制负重。结果 共有28名协作人员提供了238例踝关节骨折的数据。发现受伤时记录不佳。不到50%的后踝骨折患者进行了CT扫描以进一步评估。84%接受非手术治疗的患者未进行负重X线检查（WBXR）。进行了WBXR检查的患者更有可能被允许早期负重，但这在统计学上无显著意义。非手术治疗和手术治疗的患者中分别有59.43%和10%被允许早期负重。后踝或下胫腓联合固定的患者延迟负重比例更高。结论 威尔士在踝关节骨折治疗方面对BOAST指南的遵循情况较差。我们需要改善记录，并且在后踝骨折时应考虑进行CT扫描。应更频繁地进行负重X线检查以确定踝关节骨折的稳定性，对于被认为稳定的骨折应采用早期负重治疗。指南在固定后负重方面，尤其是后踝和/或下胫腓联合固定时，需要更加明确。
