The timeliness of ankle fracture management from presentation to discharge; our experience from a district general hospital

Introduction: Unstable ankle fractures are a common presentation and operative intervention has proven to improve patient outcomes. Each stage of patient management can have an impact on patient length of stay and clinical outcome. Materials and Methods: From April 2017 to December 2017, we retrospectively analysed the data of 49 patients with a diagnosis of an unstable ankle fracture. The patient journey was assessed from presentation to the ED right through to discharge. Post-operative notes were also reviewed. Data was obtained through our Trauma Audit and Research Network (TARN). Results: 49 patients had surgical fixation for their ankle fracture. Whilst in the ED, less than 50% of the patients had a radiographic diagnosis of an ankle fracture within 30 minutes of arrival. 25 patients were admitted to the ward within 4 hours, with some patients having to wait more than 9 hours.27 patients (more than 50%) had their surgery within 2 days after being admitted, in comparison to 6 patients who had to wait more than 6 days for their operation. The former were found to have shorter hospital length of stay post-operatively. 47 out of the 49 patients were given chemical thromboprophylaxis, all patients were advised to not weight bear for a minimum of 6 weeks, and no post-operative morbidity or mortality was encountered. Conclusion: Ankle fracture fixation, sooner rather than later, does reduce post-operative hospital LOS. There is evidence to support no added benefit to post-operative chemical thromboprohylaxis, in low risk patients, and is something we should consider