Clinical audit of the management of stable ankle fractures

Ankle fractures are common and 'stable' ankle fractures comprise 40-75% of this group. Studies show that these injuries can be managed successfully in a functional brace, with no need for further radiographs and minimal out-patient follow-up. We aimed to audit current practice and introduce change in order to improve treatment and produce financial savings.

A retrospective 6-month audit was carried out to establish practice. Guidelines were then drawn up and widely distributed in the accident and emergency (A&E) and orthopaedic departments. These included criteria for diagnosis of stable ankle fractures, a management protocol for treatment of these injuries in a brace and also a follow-up algorithm in the out-patient clinic. A prospective 6-month audit was then carried out to assess the effectiveness of the guidelines.

Of patients presenting in the second 6-month period, 91% were managed in a functional brace. The mean number of out-patient follow-up appointments, weeks until discharge and repeat radiographs all decreased significantly (P < 0.05) after the implementation of the guidelines. The cost of treating a patient with a stable ankle fracture dropped from 310.75 pounds to 129.80 pounds.

Previous studies have shown that stable ankle fractures are more effectively treated in a functional brace than a plaster cast, do not displace and, therefore, do not need repeat radiographs. A previous audit demonstrated that 60% of patients with stable fractures could be treated in a brace. We have shown that, with effective and persistent education of colleagues, the vast majority (91%) of patients can be managed in this way and this results in a significant cost saving. We have also shown that an evidence-based treatment protocol can produce significant improvements in management for patients and savings for healthcare organisations.