Ankle Fractures, Posterior Malleolus Fractures, Surgery, Syndesmotic Injuries
Conditions
Brief summary
There is a high incidence of re-operations after surgery for ankle fractures. According to the Danish Fracture Database (DFDB) the re-operation rate, excluding hardware removal, is almost 10%. We are conducting a study on the efficacy of an evidence based algorithm for the treatment of ankle fractures.
Detailed description
Treatment of ankle fractures is complex and includes assessment of fracture pattern, severity of soft-tissue involvement and general health- and functional status of the patients. Historically most fractures, undisplaced as well as displaced, were treated non-operatively with acceptable results but in recent years there is an increasing trend towards operative management of unstable fractures. Techniques for operative management of ankle fractures are varied and assessment of instability is mainly based on classic x-ray classification systems such as Lauge-Hansen or the AO that are difficult to reproduce\[6\]. We hypothesize that a standardized and evidence based approach to ankle fracture management will lead to a decrease in re-operation rate. The aim of this study is to standardize the management of ankle fractures in our department, by introducing an algorithm based on best evidence present. We want to investigate: 1. The effect of this algorithm on the re-operation rate of surgically treated ankle fractures in a two-year prospective observational setup with a minimum of one-year of follow-up. 2. The need for surgery and functional outcome of patients with isolated lateral malleolus fractures in which the treatment is dictated by ankle stability assessed on weight bearing radiographs.
Interventions
PROCEDUREPRO-malleol algorithm
An evidence based algorithm for ankle fractures
Sponsors
Hvidovre University Hospital
Study design
Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
A prospective cohort, following the introduction of an evidence based algorithm, will be compared to a matched historical cohort from the previous years.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* All patients treated for ankle fractures at our institution during the study period are asked to participate in the study.
Exclusion criteria
* Not speaking danish Not followed up at our institution Not mentally capable of filling out questionnaire
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in re-operation rate | one year | Change in re-operation rate following introduction of PRO malleol algorithm |
| Rate of surgery for isolated lateral ankle fractures | one year | Rate of surgery for isolated lateral ankle fractures, following introduction of algorithm |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| SF 36 | day 0 and 12 months | SF 36 before fracture and at 12 months |
| Ollerud Molander Ankle Score | Before fracture, 6 weeks, 12 weeks and 1 year | — |
| Forgotten Joint Score | Before fracture, 6 weeks, 12 weeks and 1 year | Before fracture, 6 weeks, 12 weeks and 1 year |
| Rate of complications not requiring surgery | One year | DVT, Nerve damage, |
Countries
Denmark
Outcome results
None listed