The acute management of ankle fractures (Augment) study: A prospective trainee led national collaborative audit of the Boast 12 guidelines

Fennelly, Joseph; Gourbault, Lysander; Stedman, Tobias; Yousuf, Umar; Senthilkumaran, Sriskandarasa; Kumar, Vish; Korde, Vinayak Amar; Baigent, Thomas; Mahmood, Fahd; Shin, Je Song; Haines, Samuel; Dominguez, Elizabeth; Monsell, Fergal; Armbruster, Berenice Aguirrezabala; Hakim, Muhammad Aadil; Dewar, Greg; Kozhikunnath, Arun; Rai, Praveen; Adebayo, Oliver; Reddy, Rajesh Gopi; Mishra, Arya; Tadros, John; Black, Jonathon; Willmott, Henry; Robertson, Alastair; Rae, Fraser; Macleod, Calum; MacLeod, Lewis; Tan, H.; Smith, Allan Ben; Chuter, G.S.J.; Slade, Henry; Javed, Omar; Adamu‐Biu, Fatima; Ho, Beatrice; Williams, Mark L.; Bull, Eleanor; Abiddin, Z.; Hannah, Andrew; Fananapazir, Leila; Rosario-Caluya, Christine Del; Hassan, Abdul Rahman; Howe, Thomas J.; Carr, Alastair; Arnaout, Firas; Knapper, Thomas; Fleming, Tom P.; Everett, Samuel James; Jordan, Stevan; Fowler, Tim; Grice, John; Taylor, Alexander; Crosswell, Sebastien; Campion, Alice; Bissell, Iain; Al-Kaisi, Kahlan; Paavana, T.; Neal‐Smith, Gregory; Bretherton, Chris; Dowlut, Naeem; Goh, En Lin; Costa, Matthew L.; Wadkin, James; Harris, Maredudd; Gill, Ian; Siddiqui, Nashat; White, Andrew A.; Chawla, Amit; Dalwai, Ramesh; Dixit, Anurag; Papachristou, Athanasios; Sharma, Akshat; Thomas, Osmond; Clifton, Laura J.; Wong, Huan; Tweedie, Blair; Drake, Benjamin; Khan, S H M; Townshend, David; Barnard, Emily; Ward, Alex; Madhvani, Kiran; Boer, Henry de; Clark, Matthew; Naveed, Umna; Chahal, Gurdip; Watts, Anna; Barkley, Sarah; Doorgakant, Ashtin; Blundell, Chris; Price, Mike; Harrison, Peter; Wright, Jake; Lesko, Laszlo; Osman, Khabab; Hartley, Laura; Uhiara, Okezika; Marsh, A.; Lloyd, Adam; Naguleswaran, Sinthuja; Khamdan, Khadija; Hartshorn, Rebecca; Sood, Abhay; Divecha, Hiren; Bryony,; Peiris,; Jaibaji, Monketh; McAndrew, Andrew; Kennedy, James A.; Yusuf, Muhammad; Rogers, Sophie; Hodhody, Ghazal; Jones, Matt Lloyd; King, Andrew; Agrawal, Somen; Stephens, Christian; Davies‐Jones, Gareth; Pirozekova, Lucia; Vick, Oliver; Kay, Robert M.; Keating, J. F.; Walsh, Nicola; Elbana, Husam; Gandavaram, Srikanth; Cash, Thomas F.; Jayatilaka, Lara; Rourke, Harry; Finnie, Stephanie; Studnicka, K; Holmes, David; Caruana, Ethan; Oputa, Tobi; Bux, Mohammed; McLauchlan, G.; Stirling, Scott; Hoggett, Lee; Peake, Chris; Duke, Kathryn; Rossiter, Daniel; Torku, David; Solan, Matthew; Anibueze, Chukwudubem; Christopher, TO; Manafa, Chibuzo; Gyimah, Dominic Ayi; Fagg, J A; Duggleby, Luke; SGARDELIS, Panagiotis; Stanger, Sophie; Barton, Tristan; Al‐Sukaini, Ahmad; Venkatesan, Mohanraj; McKerron, Sally; Balasubramanian, Sathishkumar; Koç, Togay; Dean, M. R. E.; Abdelaziz, A. Osman; Toh, Eugene; Stevenson, Robert Allen; Naqvi, Ali; Balai, Edward; Little, Max; Pearse, Michael; Sait, Saif; Drysdale, Henry; Lowdon, Hamish; Rahim, Sybghat; Davda, Kinner; Solari, Francesca; Hill, Daniel S.; Hanger, Joseph; Anderson, Kerry; Jones, Robin M.; Dutta, Agneish; Sayani, Junaid; Yeoh, Tien; Crate, Georgina; Forder, Justin; Bikkannavar, Pratik; Erotocritou, Marios; Relwani, Jiten; Singh, Saumya; Sinha, Rachel; Stringfellow, Thomas; Eves, Joshua; Asher, Dipika; Jones, Alyssa; Ali, Karar; Rajendran, Kausala; Cadwallader, Craig; Gray, Matt J.; Mani, Ravi; Ebreo, Darren; Mahoney, Rachel; Latif, Javed; Baid, Roshni; Charalambides, M.N.; Khatri, Khushboo; Zafeiris, Konstantinos N.; Charalambides, Charalambos; Taylor, Isabel K; Qulaghassi, Mahdi; Onubogu, Ifeanyi Kem; Oliver, Matthew; Manning, Christopher J.; Williams, James H.; Cheyne, N; Pillai, Anand

doi:10.1016/j.surge.2020.11.001

Cited by 4 publications

(3 citation statements)

References 15 publications

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“…Patients undergoing management for ankle fractures in SSA were on average younger and more likely to be male, compared with data from HICs [29]. Patients in the UK were mean 50 years old compared with 42 years in SSA and were 60% female compared with 44% female in SSA.…”

Section: Patient Demographicsmentioning

confidence: 92%

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Clinical outcomes of ankle fractures in sub-Saharan Africa: a systematic review

Davies

Pennington

Dhadwal³

et al. 2022

Eur J Orthop Surg Traumatol

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Purpose Ankle fractures may cause disability and socioeconomic challenges, even when managed in a high-resource setting. The outcomes of ankle fractures in sub-Saharan Africa are not widely reported. We present a systematic review of the patient-reported outcomes and complications of patients treated for ankle fractures in sub-Saharan Africa. Methods Medline, Embase, Google Scholar and the Cochrane Central Register of Controlled Trials were searched, utilising MeSH headings and Boolean search strategies. Ten papers were included. Data included patient demographics, surgical and non-surgical management, patient-reported outcome measures and evidence of complications. Results A total of 555 patients with ankle fractures were included, 471 of whom were followed up (range 6 weeks–73 months). A heterogenous mix of low-quality observational studies and two methodologically poor-quality randomised trials demonstrated mixed outcomes. A preference for surgical management was found within the published studies with 87% of closed fractures being treated operatively. A total of five different outcome scoring systems were used. Most studies included in this review were published by well-resourced organisations and as such are not representative of the actual clinical practice taking place. Conclusion The literature surrounding the clinical outcomes of ankle fractures in sub-Saharan Africa is sparse. There appears to be a preference for surgical fixation in the published literature and considering the limitations in surgical resources across sub-Saharan Africa this may not be representative of real-life care in the region.

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Section: Patient Demographicsmentioning

confidence: 92%

“…In some HICs such as the UK, guidelines exist to demonstrate optimal care for patients with ankle fractures [29,31]. Typically, more severe ankle fractures (which require realignment or are unstable) are treated with surgical management.…”

Section: Treatmentmentioning

confidence: 99%

Clinical outcomes of ankle fractures in sub-Saharan Africa: a systematic review

Davies

Pennington

Dhadwal³

et al. 2022

Eur J Orthop Surg Traumatol

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“…The BOAST guidelines for ankle fractures include rehabilitation for all patients. 35 However, the impact of physiotherapy on outcome following the treatment of ankle fractures is variable -a Cochrane review in 2008, updated in 2012, did not reveal well defined evidence for benefit of early commencement of physiotherapy (during the period of immobilization after commencement of treatment); there was also little evidence to support inter-ventions like exercise or manual therapy after the period of immobilization. 36 Whereas Zhao et al noted that initiating physiotherapy in time periods of within two days, ten days and twelve months after surgery, was ideal for reducing postoperative pain, total postoperative rate of complications and overall function of the ankle joint, respectively, Keene et al found an increase in the occurrence of surgical site infections, fixation failure and removal of hardware in association with early postoperative ankle movement.…”

Section: Discussionmentioning

confidence: 99%

Management of Ankle Fractures – A Survey of Practices of Orthopaedic Surgeons in Nigeria

Nottidge,

Ifesanya,

Shobode

et al. 2024

SLJM

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Background: Ankle fractures are fairly common worldwide but there is scanty literature on the man-agement of these fractures from sub-Saharan Africa. This study provides a broad picture of the prac-tices of orthopaedic surgeons in Nigeria in managing ankle fractures. Consequently, these practices can be updated, areas for further research highlighted and subsequently, guidelines developed con-cerning the contextual management of these fractures in Nigeria.Methods: This survey was carried out using online and hard copy questionnaires, distributed at an annual conference of the Nigerian Orthopaedic Association and sent to three regional centres of orthopaedic practice, respectively. The data was analysed to determine frequencies.Results: There were 114 male and 16 female respondents. Sixty-one percent of the respondents preferred the Danis-Weber classification. While fifty-six percent of the cohort noted that most of these patients present to traditional bone setters before seeking orthodox care, seventy percent con-sidered arrival to hospital in 1 – 4 weeks post injury to be the norm. The Ottawa ankle rules are ap-plied by most (56%) of the participants. About a sixth (17.5%) of our cohort apply syndesmosis screws routinely, while twenty-eight percent of them do not remove these screws. The commonest post-operative complications encountered were chronic pain, flap necrosis and local sepsis. Sixty percent of the surgeons regarded post-operative physiotherapy as beneficial.Conclusions: While a preference for traditional bone setter care and delayed presentation ham-pers formal care of ankle fractures, orthopaedic surgeons in Nigeria tend to apply nonoperative ap-proaches. Patient assessment and any surgical intervention are usually based on modern principles.

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