Rates of ankle fracture surgery could be reduced with better guidelines

Rates of ankle fracture surgery could be reduced with better guidelines
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The percentage of ankle fractures that lead to surgery could be reduced by 20% in the most common type of fracture, according to new research.

Researchers from the University of Gothenburg say there is a clear-cut treatment routine that could benefit both patients and caregivers. The study examined the way ankle fractures are treated in Sweden and the effect that structured guidelines could have on treatment. Currently, there are no national guidelines for ankle fracture treatment in Sweden, as is the case in many other countries.

Ankle fracture is one of the most common fracture types. Mapping of ankle fractures in Sweden has been carried out by the Swedish Fracture Register between 2012 and 2022. The study contains data on 57,433 ankle fractures.

An ankle fracture can require significant treatment

“We found that women suffer more ankle fractures than men and that most injuries occur during the winter and are the result of a same level fall, like slipping on ice or snow, for example,” said Emilia Möller Rydberg, a PhD student at the Sahlgrenska Academy at the University of Gothenburg.

Serious ankle fractures can require repeat surgery, while less serious injuries are treated more like a sprain, with an elastic bandage. The researchers outlined the difficulties involved in classifying injuries and how this can lead to reliance on the judgements of individual doctors. The researchers also described the issues with routines that are currently in place in hospitals.

According to the researchers, structured treatment routines are designed to create more fairer and more reliable assessments. When Möller Rydberg analysed patient data from before and after the introduction of guidelines at Sahlgrenska University Hospital in 2017, the affects were clear.

“We found that we reduced the number of surgeries without any increase in complications. The new treatment routine has also led to a reduction in the number of X-ray examinations, shorter plaster cast times and an increase in the number of patients permitted to exert full weight-bearing on their plaster casts,” she explained.

Unnecessary treatment can be avoided

Treatment for the most common form of ankle fracture involves differentiating stable fractures from unstable ones, which is linked to the degree of ligament injury.

The researchers recommended that in stable fractures, surgery should be avoided more often, and the percentage of surgery fell from over 30% to 10%. At the same time, the percentage of patients permitted weight-bearing on their injured ankles increased from 41% to 84%.

“It is to be hoped that these studies will lead to the more structured care of ankle fractures in the future and a reduction in the number of unnecessary operations. This has the potential to save the resources of the healthcare system and make the care of patients suffering ankle fractures more equal,” said Möller Rydberg.

“Avoiding an unnecessary operation, having a plaster cast for a shorter time and being able to put weight on your foot also has the potential to alleviate suffering for patients and speed up their return to work and activities. We shall be examining this in greater detail in the future,” she concluded.


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