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A multidisciplinary care pathway initiated during temporary external fixation for ankle and pilon fractures: A
Long Li1, Juan Huang1, Han Yan1
1Department of Foot and Ankle Surgery, Center for Orthopedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China; Orthopedic Hospital of Guangdong Province, Guangzhou, China.
Background:
Temporary external fixation is commonly used before definitive fixation for unstable ankle and pilon fractures with malalignment, dislocation, or soft-tissue compromise. This waiting period may affect mobility, self-care, psychological status, and nursing workload, yet care is not standardized.
Objective:
This study examined whether a multidisciplinary care pathway initiated during temporary external fixation was associated with early functional independence, psychological status, comfort, 12-month ankle function, satisfaction, and complications.
Methods:
This single-center retrospective historical-control cohort included 52 adults treated with temporary external fixation followed by definitive internal fixation. A total of 26 patients received routine rehabilitation care, and 26 received the multidisciplinary care pathway. Activities of daily living, psychological status, and comfort were assessed on day 3 using the Barthel Index, Mental Status Scale in Non-psychiatric Settings, and General Comfort Questionnaire. AOFAS ankle-hindfoot score, satisfaction, and complications were assessed at 12 months. Adjusted models included age, smoking history, and fracture category.
Results:
The multidisciplinary pathway group had higher day-3 ADL scores (adjusted mean difference, 8.47; 95% CI, 3.86 to 13.08) and lower MSSNS scores (-11.93; 95% CI, -17.79 to -6.06). No clear between-group differences were observed in GCQ score, 12-month AOFAS score, or hospital stay. Satisfaction favored the multidisciplinary pathway group, although a ceiling effect limited interpretation. No pin-site infection or venous thromboembolic event occurred.
Conclusions:
In this historical-control cohort, the multidisciplinary care pathway was associated with better early ADL and psychological-status scores. The study design, lack of baseline outcome measurements, and small sample size preclude causal inference.
