Review article: Best practice management of common ankle and foot injuries in the emergency department (part 2 of the musculoskeletal injuries rapid review series)

Abstract

Ankle and foot injuries are the most common musculoskeletal injuries presenting to Australian EDs and are associated with a large societal and economic impact. The quality of ED care provided to patients with ankle and foot fractures or soft tissue injuries is critical to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common ankle and foot injuries in the ED. Databases including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2017. Primary studies, systematic reviews and guidelines were considered for inclusion. English language articles published in the last 12 years that addressed the acute assessment, management or prognosis in the ED were included. Data extraction of included articles was conducted, followed by quality appraisal to rate the level of evidence where possible. The search revealed 1242 articles, of which 71 were included in the review (n = 22 primary articles, n = 35 systematic reviews and n = 14 guidelines). This rapid review provides clinicians managing fractures and soft tissue injuries of the ankle and foot in the ED a summary of the best available evidence to enhance the quality of care for optimal patient outcomes. Following a thorough history and physical examination, including the application of the Ottawa ankle rules, ED clinicians should not only provide a diagnosis, but rate the severity of soft tissue injuries, or stability of fractures and dislocations, which are the pivotal decision points in guiding ED treatment, specialist referral and the follow-up plan.

Adequacy of clinical information in X-ray referrals for traumatic ankle injury with reference to the Ottawa Ankle Rules—a retrospective clinical audit

“…Ankle and foot injuries are the most frequently presenting musculoskeletal injuries in Australian emergency departments (ED) ( Strudwick et al, 2018 ). Over 46,000 presentations occurred in South Australia in the year 2017–18 ( Australian Institute of Health and Welfare, 2018 ).…”

“…Despite the benefits of this modality, the continuous referral of patients for imaging of ankle trauma often leads to increased waiting times in the ED already been defined in the first sentence of background above, contributes to rising healthcare costs and unnecessarily exposes patients to ionising radiation ( Beckenkamp et al, 2017 ). Consequently, it is imperative that the management of ankle trauma within EDs is optimised to facilitate best management, minimise costs and improve the quality of care provided to patients ( Strudwick et al, 2018 ).…”

“…1 ) are part of a clinical decision-making tool to help clinicians accurately rule out ankle fractures, potentially precluding the need for diagnostic X-ray imaging ( Bachmann et al, 2003 ). The OAR were introduced by Stiell et al (1992) and have proven to be a highly accurate tool, with good sensitivity and demonstrated ability to reduce imaging requests and waiting times in the ED ( Cheng, Varma & Smith, 2016 ; Strudwick et al, 2018 ).…”

Reporting Discrepancy Resolved by Findings and Time in 2947 Emergency Department Ankle X-rays

“…Ankle injuries represent a significant proportion of emergency department work. They are the most common musculoskeletal injury [1] and of those presenting to the emergency department with ankle injury as their primary complaint, 15% will have an ankle fracture [2].…”

Isolated Medial Cuneiform Fractures: A Systematic Search and Qualitative Analysis of Case Studies

“…Traumatic foot injuries are a common presentation in emergency departments. [1][2][3] These injuries can cost up to $21,801 to manage and are compounded by loss of productivity and salary by the employer and employee, respectively. 4,5 The three cuneiform bones of the foot (medial, intermediate, and lateral) and their articulations are relatively small and well protected from injury, primarily due to the extensive ligamentous structures around these articulations.…”