Complication rates in operatively managed ankle fracture/dislocations: The effect of pre-reduction imaging and compliance with British Orthopaedic Association Standards for Trauma 12 guidance

Abstract

Introduction The British Orthopaedic Association Standards for Trauma (BOAST 12) guidelines for the management of ankle fractures aims to optimize recovery and reduce complications. Within the emergency department (ED), they advised urgent reduction of clinically deformed ankles, with radiographs prior only if this would not cause an unacceptable delay. The primary aim of this study was to assess the effect of time to acceptable reduction on the risk of complications and time to definitive reduction. Methods This was a retrospective observational study of patients presenting with ankle fracture dislocations between 2013 and 2017. Patients were divided into two groups with and without radiographs prior to reduction of their injury. Results A total of 242 patients were identified. The time taken from arrival to achieving an acceptable reduction was significantly longer in patients who received pre-reduction radiographs versus patients who did not (184.5 min vs 82, p < .00). The key finding of this follow-up study was that the overall risk of complications and soft tissue complications was not associated with an increased time to reduction ( p = .62). Time to definitive operative management was similar between the two sub-groups (immediate reduction 1 day vs 2, p = .72). Conclusion This study has shown that the use of pre-reduction radiographs in the management of ankle fracture dislocations significantly increases the time to reduction. However, this is not associated with an increased risk of complications or a longer time to definitive management. Further research is needed into the prognostic effect of prolonged ankle dislocation on soft tissues and long-term functional outcome.