Bin Sahl Abdullah, Barrett Ella, Abduljawad Salim M, Komber Mohamed, Al-Uzri Muntadhir, Balvinder Rana, Pillai Anand
Trauma and Orthopaedics, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, GBR.
Trauma and Orthopaedics, Royal College of Surgeons in Ireland, Dublin, IRL.
Cureus. 2024 Dec 8;16(12):e75313. doi: 10.7759/cureus.75313. eCollection 2024 Dec.
This study aimed to assess whether adherence to the British Orthopaedic Association Standards for Trauma (BOAST) and National Institute for Health and Care Excellence (NICE) guidelines for ankle fractures is associated with reduced complication rates and improved functional outcomes. Methods: A retrospective analysis was conducted of all patients who underwent surgical fixation for ankle fractures in August 2023 to January 2024 from an acute hospital. Statistical analyses were performed using IBM SPSS Statistics software, version 29 (IBM Corp., Armonk, NY), to explore the relationship between BOAST and NICE guideline adherence and the study outcomes.
The analysis revealed that only 10% of patients underwent ankle surgical fixation in accordance with the BOAST and NICE guidelines, with the mean time for surgery from injury as 10.7 days for the remaining cohort. Mental health effects were also recognised, with 26.7% due to waiting times. The association between BOAST and NICE compliance and complication incidence was found to be non-significant (p = 0.414). Mean Manchester-Oxford Foot Questionnaire (MOXFQ) scores were lower in the BOAST and NICE-compliant groups. The correlation coefficient between surgical waiting time and MOXFQ scores was r = 0.007, demonstrating no significant correlation between the time to surgery from injury and functional outcomes.
This study highlights the challenges in adhering to BOAST and NICE guidelines for timely surgical intervention in ankle fractures, with only a small proportion of patients receiving surgery within the recommended timeframe. Larger-scale studies are required to substantiate the hypothesis that early surgical intervention, as per the guidelines, leads to improved outcomes and whether achievement of the guidelines is feasible or requires re-examination.
本研究旨在评估遵循英国骨科协会创伤标准（BOAST）和英国国家卫生与临床优化研究所（NICE）踝关节骨折指南是否与降低并发症发生率及改善功能结局相关。方法：对2023年8月至2024年1月期间在一家急症医院接受踝关节骨折手术固定的所有患者进行回顾性分析。使用IBM SPSS Statistics软件29版（IBM公司，纽约州阿蒙克）进行统计分析，以探讨遵循BOAST和NICE指南与研究结局之间的关系。
分析显示，仅10%的患者按照BOAST和NICE指南接受了踝关节手术固定，其余队列的平均手术时间为受伤后10.7天。还认识到心理健康方面的影响，26.7%是由于等待时间造成的。发现遵循BOAST和NICE指南与并发症发生率之间的关联不显著（p = 0.414）。遵循BOAST和NICE指南的组中，平均曼彻斯特-牛津足部问卷（MOXFQ）得分较低。手术等待时间与MOXFQ得分之间的相关系数为r = 0.007，表明受伤至手术的时间与功能结局之间无显著相关性。
本研究突出了在踝关节骨折及时手术干预中遵循BOAST和NICE指南所面临的挑战，只有一小部分患者在推荐时间范围内接受手术。需要开展更大规模的研究，以证实按照指南进行早期手术干预会带来更好结局这一假设，以及遵循这些指南是否可行或需要重新审视。
