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Weight-bearing in ankle fractures: An audit of UK practice

2019; Elsevier BV; Volume: 39; Linguagem: Inglês

10.1016/j.foot.2019.02.005

1532-2963

James R. Gill, Emilie Lostis, Sabri Bleibleh, Michael Hennessy, Femi Thondickal, R. Gadd, Rachael Grupping, Albert Chikate, Suan Khor, Sangam Malani, William Nabulyato, Praveen Rai, Kalpesh Vaghela, Shashank Pillai, Dinnish Baskaran, Raviraj Kugapiriyan, Stanley Masunda, Jeremy S. Parker, Fiona Bintcliffe, Tom Murphy, Barry Rose, Roozbeh Shafafy, Thomas Holme, Piyush Mahapatra, Ravikanth Mallina, Reza Mansouri, Luke Render, Ashley Scrimshire, Lucy Walker, Syed Kamran Ahmed, Poonam Kandel, Benjamin Drake, Patrick A. Williams, Andrew Hannah, Zara Hayat, T. H. G. Aitken, Thomas H. Carter, Christopher Crome, Purnajyoti Banerjee, Vinoth Ravi, Victor West, James K. Bennett, Andraay Leung, David Skipsey, Mark Blomfield, Ahsan Akhtar, Khalid Al-Dadah, Emma Davies, Anna Kropelnicki, Edmund Leong, Shahbaz S. Malik, Stephen Ng Man Sun, Winster L. D'Souza, Shahid Mehmood, Gavin P. Reynolds, Mariam Sattar, Ady Abdelhaq, Alexander Durst, Albert Ngu, Alina Budacan, Matt J. Gray, Antonia Myatt, H A Claireaux, Xavier L Griffin, Navraj S. Nagra, Mustafa S. Rashid, Vishal Borse, Ross L. Muir, Roberto J.R. Alho, Thomas Ankers, Sheweidin Aziz, Ganapathy Perianayagam, Bakir Al-Dulaimy, Marieta D Franklin, Purwa Wilson, Mallikarjun Honnenahalli Chandrappa, Latif Mubasher, Rizwan Shahid, Singapura Shashidhara, Yiteng Xu, Ghazal Hodhody, John Jeffery, Simon Humphry, Julia Street, Tariq Yasin, Jasprit Kaur, Richard L. Donovan, Steven Kahane, Lee D. Parker, Hayleigh Byrne, Sushmith Gowda, Barbara Frank, Ravikiran Shenoy, Abhinav Singh, Sunil Trakru, Paul Brewer, Mike Petrie, Ghias Bhattee, Michael Rafferty, Quen Tang, Mohamed Elbashir, Vladislav Kutuzov, Kate Spacey, Darren Ebreo, Shreekant Gupta, Usman Ahmed, Mohammed Al Mustafa, Seyed Asghar Ali, Govind Singh S. Chauhan, Saad Elashry, Naeil Lotfi, Shahbaz S. Malik, A. Marsh, Iosif Pagkalos, Raghunaathan Rangan, Parag Raval, Islam Sarhan, Yousufuddin Shaik, Rajkumar Thangaraj, Feiran Wu, Zainab Kazmi, Chia Yew Kong, Moritz Lebe, Surjit Lidder, Sean P. Masterson, Farzad Shabani, Adeel Ikram, Ben A. Marson, Paul A. Matthews, Ganesh Prasad, James M. Davenport, Mike Karski, K.V. Syam, Nithin Unnikrishnan, R Abu-Rajab, Ignatius Liew, Niak Puei Koh, J.L. Barrie, A Goubran, Lucy Maling, Edward Karam, Richard Limb, George Matheron, Fady Awad, Kimberely Shuttlewood, Jack Pearce, Kar Hao Teoh, Jo Higgins, Togay Koç, John McFall, George Holland, Julian F. Maempel, Jamie A. Nicholson, Neil R. Wickramasinghe, Andrew Berg, David Knowles, Naeem Dowlut, Mehvish Hayat, James Thomas Bourne, Leanne Dupley, Min Soo S.K. Kim, Mark Poustie, Laura Bowen, R. Fawdington, Lawrence Stephen Moulton, Helen Ribee, Charlotte Tunstall, Robert Boyd, Jonathan Quayle, Felicity Auld, Simon Bellringer, Lucy Cassidy, Arunray Ray, Benedict A. Rogers, Richard Kapur, Katerina Kyprianou, Payam Tarassoli, John Ferns, Maire-Clare Killen, Hartej Sur, Yin Wan Tam, Sathish Bala, R Lunevicius, Ryan Higgin, Jonathan Topping, Sean Duffy, Peter Robinson, Mike Stoddart, Ali Altaweel, Ernest Chew, Ravi Popat, Aadhar Sharma, Rupert Wharton, Samantha Hook, Taran Khangura, Sheena Seewoonarain, Sian Sokota, Charlotte Cross, Kathryn Mcloughlin, Frances Andrews, Chris Bretherton, Jennie M. Simpson, Andreea Lupu, Charlotte T Thomas, Blair Tweedie, Kedar Chirputka, Bernard Ferns, Steven Ross, Yuhao Zhang, Christopher Goodland, Benjamin Barkham, Jagmeet Bhamra, Rory Cuthbert, Arun Nair, R. W. Payne, Matthew Weston, Ryan Wong, Tom Wood, Philip Thomas, Hannah Wilkinson, Muhammad Adeelakhtar, Jo-Ann Bate, Bernardo Brandao, Martin Lovell, Richard Unsworth, R.A.E. Clayton, Liam Z. Yapp, Ravi Badgetu, Mike Hughes, Sophia Burns, Ling Kho, Lily Li, Douglas Evans, C S Fenner, Kartik Logishetty, Sam Nahas, Subra Nathan, Karadi Kumar, Oliver Negus, Gemma Salt, Shahrier Sarker, Nicola Blucher, Shirley Lyle, Christopher Buckle, Chibuzo Manafa, Mark Jones, Krasimir Nachev, Junaid Sayani, Olatoyosi Williams, James A. Cruickshank, Nicholas Edwards,

Bone fractures and treatments

The purpose of this national study was to audit the weight-bearing practice of orthopaedic services in the National Health Service (NHS) in the treatment of operatively and non-operatively treated ankle fractures. A multicentre prospective two-week audit of all adult ankle fractures was conducted between July 3rd 2017 and July 17th 2017. Fractures were classified using the AO/OTA classification. Fractures fixed with syndesmosis screws or unstable fractures (>1 malleolus fractured or talar shift present) treated conservatively were excluded. No outcome data were collected. In line with NICE (The National Institute for Health and Care Excellence) criteria, "early" weight-bearing was defined as unrestricted weight-bearing on the affected leg within 3 weeks of injury or surgery and "delayed" weight-bearing as unrestricted weight-bearing permitted after 3 weeks. 251 collaborators from 81 NHS hospitals collected data: 531 patients were managed non-operatively and 276 operatively. The mean age was 52.6 years and 50.5 respectively. 81% of non-operatively managed patients were instructed for early weight-bearing as recommended by NICE. In contrast, only 21% of operatively managed patients were instructed for early weight-bearing. The majority of patients with uni-malleolar ankle fractures which are managed non-operatively are treated in accordance with NICE guidance. There is notable variability amongst and within NHS hospitals in the weight-bearing instructions given to patients with operatively managed ankle fractures. This study demonstrates community equipoise and suggests that the randomized study to determine the most effective strategy for postoperative weight-bearing in ankle fractures described in the NICE research recommendation is feasible.