Weight-bearing in ankle fractures: An audit of UK practice. (June 2019)

• Record Type: Journal Article
• Authors: Gill, James R.; Lostis, Emilie; Bleibleh, Sabri S.; Hennessy, Michael S.; Thondickal, Femi; Gadd, Richard J.; Grupping, Rachael; Chikate, Albert; Khor, Suan; Malani, Sangam; Nabulyato, William; Rai, Praveen; Vaghela, Kalpesh R.; Pillai, Shashank; Baskaran, Dinnish; Kugapiriyan, Raviraj; Masunda, Stanley; Parker, Jeremy; Bintcliffe, Fiona; Murphy, Tom; Rose, Barry; Shafafy, Roozbeh; Holme, Thomas; Mahapatra, Piyush; Mallina, Ravikanth; Mansouri, Reza; Render, Luke; Scrimshire, Ashley; Walker, Lucy; Ahmed, Syed; Kandel, Poonam; Drake, Benjamin; Williams, Patrick; Hannah, Andrew; Hayat, Zara; Aitken, Thomas; Carter, Thomas H.; Crome, Christopher; Banerjee, Purnajyoti; Ravi, Vinoth; West, Victor; Bennett, James; Leung, Andraay; Skipsey, David; Blomfield, Mark; Akhtar, Ahsan; Al-Dadah, Khalid; Davies, Emma; Kropelnicki, Anna; Leong, Edmund; Malik, Sheraz; Sun, Stephen Ng Man; D'Souza, Winster; Mehmood, Shahid; Reynolds, Gavin; Sattar, Mariam; Abdelhaq, Ady; Durst, Alexander; Ngu, Albert; Budacan, Alina; Gray, Matt; Myatt, Antonia; Claireaux, Henry A.; Griffin, Xavier L.; Nagra, Navraj S.; Rashid, Mustafa; Borse, Vishal; Muir, Ross; Alho, Roberto J.R.; Ankers, Thomas; Aziz, Sheweidin; Perianayagam, Ganapathy; Al-Dulaimy, Bakir; Franklin, Marieta; Wilson, Purwa; Chandrappa, Mallikarjun; Mubasher, Latif; Shahid, Rizwan; Shashidhara, Singapura; Xu, Yiteng; Hodhody, Ghazal; Jeffery, John; Humphry, Simon; Street, Julia; Yasin, Tariq; Kaur, Jasprit; Donovan, Richard L.; Kahane, Steve; Parker, Lee; Byrne, Hayleigh; Gowda, Sushmith; Frank, Barbara; Shenoy, Ravikiran; Singh, Abhinav; Trakru, Sunil; Brewer, Paul; Petrie, Mike; Bhattee, Ghias; Rafferty, Michael; Tang, Quen O.; Elbashir, Mohamed; Kutuzov, Vladislav; Spacey, Kate; Ebreo, Darren; Gupta, Shreekant; Ahmed, Usman; Mustafa, Mohammed Al; Ali, Seyed; Chauhan, Govind Singh S.; Elashry, Saad; Lotfi, Naeil; Malik, Shahbaz; Marsh, Alastair; Pagkalos, Iosif; Rangan, Raghunaathan; Raval, Parag; Sarhan, Islam; Shaik, Yousufuddin; Thangaraj, Rajkumar; Wu, Feiran; Kazmi, Zainab; Kong, Chia Yew Y.; Lebe, Moritz; Lidder, Surjit; Masterson, Sean; Shabani, Farzad; Ikram, Adeel; Marson, Ben A.; Matthews, Paul; Prasad, Ganesh; Davenport, James; Karski, Mike; Syam, Kevin; Unnikrishnan, Nithin; Abu-Rajab, Rashid; Liew, Ignatius; Koh, Niak Puei; Barrie, Jim; Goubran, Alex; Maling, Lucy; Karam, Edward; Limb, Richard; Matheron, George; Awad, Fady; Shuttlewood, Kimberely; Pearce, Jack; Teoh, Kar H.; Higgins, Jo; Koc, Togay; Mcfall, John; Holland, George; Maempel, Julian F.; Nicholson, Jamie; Wickramasinghe, Neil; Berg, Andrew J.; Knowles, David; Dowlut, Naeem; Hayat, Mehvish; Bourne, James T.; Dupley, Leanne; Kim, Min Soo S.K.; Poustie, Mark; Bowen, Laura; Fawdington, Ross A.; Moulton, Lawrence S; Ribee, Helen; Tunstall, Charlotte; Boyd, Robert; Quayle, Jonathan; Auld, Felicity; Bellringer, Simon F; Cassidy, Lucy; Ray, Arunray; Rogers, Benedict; Kapur, Richard; Kyprianou, Katerina; Tarassoli, Payam; Ferns, John; Killen, Maire-Clare; Sur, Hartej; Tam, Yin; Bala, Sathish; Das, Rishi; Higgin, Ryan; Topping, Jonathan; Duffy, Sean; Robinson, Peter; Stoddart, Mike; AlTaweel, Ali; Chew, Ernest; Popat, Ravi; Sharma, Aadhar; Wharton, Rupert; Hook, Samantha; Khangura, Taran; Seewoonarain, Sheena; Sokota, Sian; Cross, Charlotte E; Mcloughlin, Kathryn; Andrews, Frances; Bretherton, Chris P; Simpson, Jennie; Lupu, Andreea; Thomas, Charlotte T; Tweedie, Blair; Chirputka, Kedar; Ferns, Bernard; Ross, Steven; Zhang, Yuhao; Goodland, Christopher; Barkham, Benjamin; Bhamra, Jagmeet; Cuthbert, Rory; Nair, Arun; Payne, Robert; Weston, Matthew; Wong, Ryan; Wood, Tom; Thomas, Philip; Wilkinson, Hannah; Adeelakhtar, Muhammad; Bate, Jo-Ann; Brandao, Bernardo Duarte; Lovell, Martin; Unsworth, Richard; Clayton, Robert; Yapp, Liam; Badgetu, Ravi; Hughes, Mike; Burns, Sophia; Kho, Ling; Li, Lily; Evans, Douglas; Fenner, Christopher; Logishetty, Kartik; Nahas, Sam; Nathan, Subra; Kumar, Karadi; Negus, Oliver; Salt, Gemma; Sarker, Shahrier; Blucher, Nicola; Lyle, Shirley; Buckle, Christopher; Chibuzo, Manafa; Jones, Mark; Nachev, Krasimir; Sayani, Junaid; Williams, Olatoyosi; Cruickshank, James; Edwards, Nicholas;
• Is Part Of: Foot. Volume 39(2019)
• Page Start: 28
• Page End: 36
• Publication Date: 2019-06
• Subjects: Fractures -- Ankle -- Weight-bearing -- Early -- Delayed -- NICE; Foot -- Diseases -- Periodicals; Foot -- Surgery -- Periodicals; Foot Diseases -- Periodicals; Foot -- surgery -- Periodicals; Pied -- Maladies -- Périodiques; Pied -- Chirurgie -- Périodiques; Pied -- Lésions et blessures -- Périodiques; Foot -- Diseases; Foot -- Surgery; Periodicals; Electronic journals; Electronic journals; 617.585005
• DOI: 10.1016/j.foot.2019.02.005
• Languages: English
• ISSNs: 0958-2592

Abstract

Graphical abstract: Highlights: The standard of care for weight-bearing after ankle fracture was previously unknown. 81% of non-operatively managed patients with uni-malleolar fractures are advised early weight-bearing. 21% of operatively managed patients are advised early weight-bearing. There is community equipoise and a randomized study examining weight-bearing in ankle fractures is feasible. Abstract: Introduction: The purpose of this national study was to audit the weight-bearing practice of orthopaedic services in the National Health Service (NHS) in the treatment of operatively and non-operatively treated ankle fractures. Methods: A multicentre prospective two-week audit of all adult ankle fractures was conducted between July 3rd 2017 and July 17th 2017. Fractures were classified using the AO/OTA classification. Fractures fixed with syndesmosis screws or unstable fractures (>1 malleolus fractured or talar shift present) treated conservatively were excluded. No outcome data were collected. In line with NICE (The National Institute for Health and Care Excellence) criteria, "early" weight-bearing was defined as unrestricted weight-bearing on the affected leg within 3 weeks of injury or surgery and "delayed" weight-bearing as unrestricted weight-bearing permitted after 3 weeks. Results: 251 collaborators from 81 NHS hospitals collected data: 531 patients were managed non-operatively and 276 operatively. The mean age was 52.6 years and 50.5 respectively. 81% of non-operatively managed patients were instructed for early weight-bearing as recommended by NICE. In contrast, only 21% of operatively managed patients were instructed for early weight-bearing. Discussion: The majority of patients with uni-malleolar ankle fractures which are managed non-operatively are treated in accordance with NICE guidance. There is notable variability amongst and within NHS hospitals in the weight-bearing instructions given to patients with operatively managed ankle fractures. Conclusion: This study demonstrates community equipoise and suggests that the randomized study to determine the most effective strategy for postoperative weight-bearing in ankle fractures described in the NICE research recommendation is feasible.