Ankle fractures – An audit of BOAST 12 guidelines
Aim: The British Orthopaedic Association introduced an Audit Standard for Trauma (BOAST) related to the management of ankle fractures in 2016. We aim to audit Royal Derby Hospital compliance with a specified standard for practice – ‘early fixation (on the day or day after injury) is recommended in the majority of patients under 60 years’. We also compare compliance with that of a local district general hospital. Method: Retrospective analysis of patients presenting to Royal Derby Hospital with unstable ankle fractures from 29/01/2018-03/06/2018. Pilon, open and skeletally immature fractures and patients >60 years were excluded. Data related to time of presentation and fixation was collected. Casenotes were reviewed in patients with fixation delay to clarify cause. Length of inpatient stay was also recorded. Identical data was obtained at King’s Mill Hospital. Results: 53 patients presented to Royal Derby Hospital; of which 27 fulfilled our inclusion criteria. 14 patients (52%) fulfilled audit standard of undergoing fixation on the day or day after injury. Mean number of days between presentation and fixation was 4 (median 1; range 1-17). 62% (n=34) fulfilled audit standard at King’s Mill Hospital. Of those patients that did not fulfil the audit standard, 46% remained an inpatient whilst awaiting optimisation of their soft tissue status. 39% had had an initial trial of non-operative treatment. 15% were granted home leave and attended fracture clinic for a preoperative swelling check. At King’s Mill Hospital 40% of those that did not fulfil audit standard remained an inpatient. Conclusion: Audit compliance at Royal Derby Hospital is comparable to that of a local district general hospital. Recommendations: Endeavour to prioritise early fixation of unstable ankle fractures. However, when surgical intervention is delayed due to capacity issues, suitable patients should be discharged home with advice to strictly elevate the injured limb. The patient can then be readmitted on an urgent elective basis for fixation.
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