Weight-bearing in ankle fractures: An audit of UK practice

Gill, James R.; Lostis, Emilie; Bleibleh, Sabri; Hennessy, Michael S.; Thondickal, Femi; Gadd, R.; Grupping, Rachael; Chikate, Albert; Khor, Suan; Malani, Sangam; Nabulyato, William; Rai, Praveen; Vaghela, Kalpesh R.; Pillai, S.C.B; Baskaran, Dinnish; Kugapiriyan, Raviraj; Masunda, Stanley; Parker, Jeremy S.; Bintcliffe, F; Murphy, Tom; Rose, Barry; Shafafy, Roozbeh; Holme, Thomas J; Mahapatra, Piyush; Mallina, Ravikanth; Mansouri, Reza; Render, Luke; Scrimshire, Ashley B; Walker, Lucy; Ahmed, Syed Kamran; Kandel, Poonam; Drake, Benjamin; Williams, Patrick A.; Hannah, Andrew; Hayat, Zara; Aitken, T. H. G.; Carter, Thomas H.; Crome, Christopher; Banerjee, Purnajyoti; Ravi, Vinoth; West, Victor; Bennett, James; Leung, Andraay; Skipsey, David; Blomfield, Mark; Akhtar, Ahsan; Al-Dadah, Khalid; Davies, Emma; Kropelnicki, Anna; Leong, Edmund; Malik, Sheraz S.; Sun, Stephen Ng Man; D'Souza, Winster L.; Mehmood, Shahid; Reynolds, Gavin P.; Sattar, Mariam; Abdelhaq, Ady; Durst, Alexander; Ngu, Albert; Budacan, Alina; Gray, Matt J.; Myatt, A.; Claireaux, Henry; Griffin, Xavier L; Nagra, Navraj S.; Rashid, Mustafa S.; Borse, Vishal; Muir, Ross L.; Alho, Roberto J.R.; Ankers, Thomas; Aziz, Sheweidin; Perianayagam, Ganapathy; Al-Dulaimy, Bakir; Franklin, Marieta; Wilson, Purwa; Chandrappa, Mallikarjun Honnenahalli; Mubasher, Latif; Shahid, Rizwan; Shashidhara, Singapura; Xu, Yiteng; Hodhody, Ghazal; Jeffery, John; Humphry, Simon; Street, Julia; Yasin, Tariq; Kaur, Jasprit; Donovan, Richard L; Kahane, Steve; Parker, Lee D.; Byrne, Hayleigh; Gowda, Sushmith; Frank, Barbara; Shenoy, Ravikiran; Singh, Abhinav; Trakru, Sunil; Brewer, Paul; Petrie, Mike; Bhattee, Ghias; Rafferty, M; Tang, Quen; Elbashir, Mohamed; Kutuzov, Vladislav; Spacey, Kate; Ebreo, Darren; Gupta, Shreekant; Ahmed, Usman; Mustafa, Mohammed Al; Ali, S. A.; Chauhan, Govind Singh S.; Elashry, Saad; Lotfi, Naeil; Malik, Shahbaz S.; Marsh, A.; Pagkalos, I.; Rangan, Raghunaathan; Raval, Parag; Sarhan, Islam; Shaik, Yousufuddin; Thangaraj, Rajkumar; Wu, Feiran; Kazmi, Zainab; Kong, Chia Yew; Lebe, Moritz; Lidder, Surjit; Masterson, Sean P.; Shabani, Farzad; Ikram, Adeel; Marson, Ben; Matthews, Paul A.; Prasad, Ganesh; Davenport, James M.; Karski, Mike; Syam, K.V.; Unnikrishnan, N.; Abu-Rajab, R.; Liew, Ignatius; Koh, Niak Puei; Barrie, J.L.; Goubran, Alex; Maling, Lucy; Karam, Edward; Limb, Richard; Matheron, George; Awad, Fady; Shuttlewood, K.; Pearce, J.; Teoh, Kar Hao; J, Higgins; Koç, Togay; McFall, John; Holland, George A.; Maempel, Julian F.; Nicholson, Jamie A; Wickramasinghe, Neil R; Berg, Andrew; Knowles, David; Dowlut, Naeem; Hayat, Mehvish; Bourne, James Thomas; Dupley, Leanne; Kim, Min Soo S.K.; Poustie, Mark; Bowen, Laura; Fawdington, Ross A; Moulton, Lawrence Stephen; Ribee, Helen; Tunstall, Charlotte; Boyd, Robert; Quayle, Jonathan; Auld, Felicity; Bellringer, Simon; Cassidy, Lucy; Ray, Arunray; Rogers, Benedict A.; Kapur, Richard; Kyprianou, Katerina; Tarassoli, Payam; Ferns, John; Killen, Maire-Clare; Sur, Hartej; Tam, Yin; Bala, Sathish; Das, Rishi; Higgin, Ryan P.C.; Topping, Jonathan; Duffy, Sean; Robinson, Peter; Stoddart, Mike; Altaweel, Ali; Chew, Ernest; Popat, Ravi; Sharma, Aadhar; Wharton, Rupert; Hook, Samantha; Khangura, Taran; Seewoonarain, Sheena; Sokota, Sian; Cross, Charlotte; Mcloughlin, Kathryn; Andrews, Frances; Bretherton, Chris; Simpson, Jennie; Lupu, Andreea; Thomas, Charlotte T; Tweedie, Blair; Chirputka, Kedar; Ferns, Bernard; Ross, Steven; Zhang, Yuhao; Goodland, Christopher; Barkham, Benjamin; Bhamra, Jagmeet; Cuthbert, Rory; Nair, Arun; Payne, R. W.; Weston, Matthew; Wong, Rebecca; Wood, Tom; Thomas, Philip; Wilkinson, Hannah; Adeelakhtar, Muhammad; Bate, Jo-Ann; Brandao, Bernardo; Lovell, Martin; Unsworth, Richard; Clayton, R.A.E.; Yapp, Liam Z; Badgetu, Ravi; Hughes, Mike; Burns, Sophia; Kho, Ling; Li, Lily; Evans, D. Gareth; Fenner, C; Logishetty, Kartik; Nahas, Sam; Nathan, Subra; Kumar, K. Avinash; Negus, Oliver; Salt, Gemma; Sarker, Shahrier; Blucher, Nicola; Lyle, Shirley; Buckle, Christopher; Manafa, Chibuzo; Jones, Mark; Nachev, Krasimir; Sayani, Junaid; Williams, Olatoyosi; Cruickshank, James A.; Edwards, Nicholas A.

doi:10.1016/j.foot.2019.02.005

Cited by 10 publications

(6 citation statements)

References 21 publications

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“…The results of this study are poor as compared to a recent trainee collaborative study on ankle fractures [4].…”

Section: Discussioncontrasting

confidence: 75%

“…In the United Kingdom, the British Orthopedic Association (BOA) and the British Orthopedic Foot and Ankle Society (BOFAS) have suggested national standards, British Orthopedic Association Standards for Trauma (BOAST) guidelines for the management of ankle fractures, which also reflect recommendations from National Institute for Health and Care Excellence (NICE) [3]. However, there remains much controversy and variations in practice, especially with regards to the weight-bearing status in both operatively and non-operatively managed ankle fractures [4]. Early weight-bearing in these fractures has been shown to reduce thromboembolic events, improve functional outcomes, early return to work, and or pre-injury status.…”

Section: Introductionmentioning

confidence: 99%

“…However, there remains the risk of displacement of fractures resulting in malunion, need for further surgery, and early-onset ankle arthritis [5,6]. Multiple recent studies have utilized the power of trainee research collaborative (TRC) networks to gather data from a large number of patients from hospitals across wide geographical areas in a short period [4,7,8]. These have encouraged high-quality multi-center research to limit bias and increase the external validity of the study results, as well as to nurture a culture of collaboration.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Results From an All Wales Trainee Led Collaborative Prospective Audit on Management of Ankle Fractures

Gokhale¹,

D’sa²,

Agarwal³

et al. 2021

Cureus

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“…The results of this study are poor as compared to a recent trainee collaborative study on ankle fractures [4].…”

Section: Discussioncontrasting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Results From an All Wales Trainee Led Collaborative Prospective Audit on Management of Ankle Fractures

Gokhale¹,

D’sa²,

Agarwal³

et al. 2021

Cureus

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

“…Considering the significant difficulty that older individuals face in tolerating weight-bearing restrictions there is a need for further research into the most appropriate weightbearing protocols for ankle fractures, which is unclear and there is evidence of inconsistency in clinical practice. [16][17][18] In some cases, weight-bearing may provide more benefits than harm and further evaluation of these protocols is warranted. In instances where weight-bearing restrictions are deemed essential, consideration of alternative or innovative walking aids would be helpful to ensure restrictions are able to be adhered to.…”

Section: Discussionmentioning

confidence: 99%

Patient experiences of an ankle fracture and the most important factors in their recovery: a qualitative interview study

et al. 2020

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ObjectiveThe objective of this qualitative research study is to explore patient experiences of ankle fracture and the factors most important to them in recovery.DesignSemistructured interviews exploring patient experiences of ankle fracture recovery at 16–23 weeks following injury. Interviews followed a topic guide and were recorded with an encrypted audio recorder and then transcribed verbatim. Thematic content analysis was used to identify themes in the data.SettingIndividuals were recruited from a sample of participants of a UK-based clinical trial of immobilisation methods for ankle fracture (ISRCTN15537280 at the pre-results stage at time of writing). Interviews were conducted at the participants’ own homes or on a university campus setting.ParticipantsA purposive sample was used to account for key variables of age, gender and fracture management. Participants recruited from the clinical trial sample were adults aged 18 years or over with a closed ankle fracture.ResultsTen participants were interviewed, five of whom were female and six of whom needed an operation to fix their ankle fracture. The age range of participants was 21–75 years with a mean of 51.6 years. Eight themes emerged from the data during analysis; mobility, loss of independence, healthcare, psychological effects, social and family life, ankle symptoms, sleep disturbance and fatigue, and activities of daily living. Factors of importance to participants included regaining their independence, sleep quality and quantity, ability to drive, ability to walk without walking aids or weight-bearing restrictions, and radiological union.ConclusionsThe results of this research demonstrates the extensive impact of ankle fracture on individuals’ lives, including social and family life, sleep, their sense of independence and psychological well-being. The results of this study will enable an increased understanding of the factors of relevance to individuals with ankle fracture, allowing collection of appropriate outcomes in clinical studies for this condition. Ultimately these results will help formulate appropriate patient-centred rehabilitation plans for these patients.Trial registration numberISRCTN15537280; Pre-results

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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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Weight-bearing in ankle fractures: An audit of UK practice

Cited by 10 publications

References 21 publications

Results From an All Wales Trainee Led Collaborative Prospective Audit on Management of Ankle Fractures

Results From an All Wales Trainee Led Collaborative Prospective Audit on Management of Ankle Fractures

Patient experiences of an ankle fracture and the most important factors in their recovery: a qualitative interview study

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

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