1061 Improving the Emergency Management of Unstable Ankle Fractures in a District General Hospital: A Quality Improvement Project

Abstract

Abstract Aim To assess and improve initial casting techniques in the emergency management of unstable ankle fractures. Method All patients who underwent operative management of ankle fractures over two consecutive 3-month periods were selected, before and after an intervention. Following the first cycle, an intervention included presentation of results and teaching delivery to the Emergency Department, with agreement to advocate for backslab as preferred casting technique. Results A total of fifty-two patients were identified, with an age range of 8 to 96 years. The majority were female (63%). Initial results demonstrated 61% were managed in below ankle backslabs, 33% in full casts and 1 patient in a moonboot. Subsequent loss of reduction was demonstrated in 27% of patients. Rates were higher with full casts (45.4%) compared to backslabs (20%). Following intervention, results demonstrated a 28% increase in use of backslab casting method (89%). Only 5% were managed with a full cast (28% decrease) and 1 inappropriately discharged without immobilisation. There was a 7% decrease in overall loss of reduction (21%). There was no loss of reduction within the full cast group and 22% with backslab management. Conclusions The use of backslab immobilisation in the management of unstable ankle fractures is preferred. Following a brief intervention, rates of backslab immobilisation increased and loss of reduction decreased. Results show an improvement in casting techniques in the management of these patients in an NHS Trust.