Video-assisted resident education is associated with improved ankle joint reduction: A prospective controlled study

Proper fracture reduction and splinting technique is critical for soft tissue protection and fracture stability in the acute management of ankle fractures. However, residency education for acute ankle fracture reduction and splinting techniques remains poorly standardized and streamlined. This study evaluated the effect of implementing a video-assisted ankle fracture management education program administered to first-year orthopaedic residents on ankle joint reduction and splint quality.

This was a prospective controlled study conducted at a single level I trauma center. All consecutive ankle fractures (OTA/AO: 4F, 44) requiring the placement of a bivalved short leg cast or AO splint from January 1, 2019, to June 30th, 2022 were included. Exclusion criteria included skeletal immaturity, missing imaging, delayed fracture presentation more than two weeks from injury, concurrent ipsilateral injury/polytrauma interfering with ankle reduction, open fracture, or ankle fractures treated without an AO splint or cast. The primary outcome was joint reduction quality defined as radiographic post-reduction tibiofibular overlap, tibiofibular clear space, and medial clear space. Secondary outcomes included splint padding thickness and ankle dorsiflexion angle to assess splint quality.

A total of 280 consecutive ankle fracture cases were included for evaluation of splint quality: 111 in the intervention group (mean age 46; [range 14-92]; 44% female) versus 169 in the control group (mean age 44; [range 14-90]; 41% female). Comparable injury severity was observed between groups. In the supination-external rotation IV (SER4) and type IV-equivalent (SER4e) subgroup, there was significant improvement in joint reduction quality in the intervention group as compared to control (55% versus 36%, respectively; Risk Ratio: 1.52, [95% CI: 1.03-2.25], p = 0.04). In the entire cohort, splint padding thickness was not significantly improved in the intervention group (p > 0.05), however, there was a significant increase in the percentage of ankles splinted in an appropriately dorsiflexed position (p = 0.03).

Implementation of video-assisted ankle fracture management education program was associated with improvements in overall ankle joint reduction quality. While the clinical significance of the improvements observed in ankle reduction remains yet to be established, orthopaedic surgery residency programs should consider incorporating video technique guides into their educational curricula.

Level II, Therapeutic Study.