Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden.
BMC Musculoskelet Disord. 2022 Apr 29;23(1):401. doi: 10.1186/s12891-022-05358-x.
In 2015 a study of isolated lateral malleolar fractures (AO/OTA44-B1) treated at Sahlgrenska University hospital (SU) during two consecutive years revealed large-scale variation in the choice of treatment and planned follow-up. The study resulted in the development of a structured treatment algorithm (TA) for ankle fractures. We investigated the effects of this well-implemented TA on the classification, treatment and follow-up of lateral malleolar fractures.
The current study is an uncontrolled, non-randomized, retrospective before-and-after study comparing a group of AO/OTA44-B1 fractures treated at SU before the introduction of the TA for ankle fractures (1 April 2012 to 31 March 2014) with a group treated after the introduction of the TA (1 September 2017 to 31 August 2019).
In all the studied parameters regarding treatment for AO/OTA44-B1 fractures, a statistically significant change was seen after the introduction of the TA. Surgical treatment reduced from 32% (95% CI 27.5 - 36.5) pre-TA to 10% (95% CI 6.9 - 13.1) post-TA, while the number of patients permitted full weight-bearing increased from 41% (95% CI 36.3 - 45.7) to 84% (95% CI 80.1 - 87.9).
A thoroughly implemented treatment algorithm can reduce the number of surgical treatments for stable ankle fractures. The current study demonstrates that a structured treatment algorithm can standardize the management of ankle fractures and make decisions less dependent on the surgeon's discretion.
2015 年，一项对在连续两年内于 Sahlgrenska 大学医院（SU）治疗的孤立外踝骨折（AO/OTA44-B1）的研究表明，在治疗选择和计划随访方面存在大规模差异。该研究促成了踝关节骨折结构化治疗算法（TA）的发展。我们调查了这种实施良好的 TA 对外侧踝骨折的分类、治疗和随访的影响。
本研究为一项非随机、回顾性、前后对照研究，比较了一组在引入踝关节骨折 TA 之前（2012 年 4 月 1 日至 2014 年 3 月 31 日）在 SU 治疗的 AO/OTA44-B1 骨折患者，以及一组在引入 TA 后（2017 年 9 月 1 日至 2019 年 8 月 31 日）治疗的患者。
在所有关于治疗 AO/OTA44-B1 骨折的研究参数中，在引入 TA 后均出现了统计学显著变化。手术治疗从 TA 前的 32%（95%CI 27.5-36.5）降至 TA 后的 10%（95%CI 6.9-13.1），而允许完全负重的患者数量从 41%（95%CI 36.3-45.7）增加到 84%（95%CI 80.1-87.9）。
彻底实施的治疗算法可以减少稳定踝关节骨折的手术治疗数量。本研究表明，结构化治疗算法可以标准化踝关节骨折的管理，并使决策更少依赖于外科医生的裁量权。
