Ankle fracture dislocations treated later in the day had delayed reduction, worse outcomes
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Results presented at the Virtual EFORT Congress showed patients with ankle fracture dislocations who presented at an ED later in the day had increased delay to ankle reduction and worse functional outcomes at 1 year.
Abdus Samee Wasim and colleagues assessed time of attendance to an ED alongside efficacy and timing of initial reduction among 27 patients with ankle fracture dislocations requiring surgery between March 2018 and March 2019. Researchers also assessed compliance of British Orthopaedic Association ankle fracture dislocation guidelines regarding congruency of joint on X-ray on leaving ED following reduction, as well as the impact on long-term functional outcomes with the EuroQol-5D. Researchers analyzed data for any clinically significant impact on the patient management pathway, length of stay and financial analysis.
Wasim noted patients were categorized into groups based on whether they presented at an ED with an ankle fracture dislocation during the morning, afternoon or night. Patients in the morning cohort had a significantly shorter average time to first attempted reduction vs. patients in the afternoon or night cohorts, according to Wasim.
“We also found that there were a lower percentage of patients that were leaving the ED with an ankle dislocation, with 11% in the morning and 25% and 16%, respectively, in the afternoon and night,” Wasim said in his presentation.
He added patients attending an ED in the morning had a reduced inpatient length of stay, as well as a lower number of fracture clinic follow-up appointments vs. patients who attended an ED at night. Results showed patients in the morning cohort had the lowest change in EQ-5D scores between before and after ankle fracture compared with patients in the afternoon and night cohorts.
“Our key recommendation was that interventions needed to be applied to our local practice to include the provision of practical teaching sessions and educational literature to train newer staff in the methods of reduction to promote competent early reduction and improved clinical outcomes,” Wasim said.
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Wasim AS, et al. Paper 446. Presented at: Virtual EFORT Congress; June 30 – July 2, 2021.
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