Ankle fractures: Emergency department management…is there room for improvement?

Objective The aim of this study was to identify pitfalls in the acute management of ankle fractures which were referred to a regional orthopaedic unit. This unit provides orthopaedic services for the catchment area of the Waterford Emergency Department together with three additional emergency units in the south-eastern region of Ireland. Methods This is a retrospective study of all patients referred to the Waterford Regional Orthopaedic service from 1 January 2001 to 31 December 2001 for management of acute ankle fractures. Results A total of 236 patients were identified during the study period. Open reduction and internal fixation were performed in 200 cases. In all, 52% of patients had definitive surgery within 24 h of their injury. These patients were evenly distributed between regional (64%) and peripheral (60%) emergency unit referrals. 24% of patients required essential manipulation prior to surgery. This had been performed in only 34% of cases prior to transfer. Two patients were transferred with a pulseless foot. Conclusions Ankle fractures are a common musculoskeletal injury seen in emergency departments and minor injury units. Long-term disability resulting from ankle fractures can be reduced by optimal early management procedures. This is an important area for consideration in education programmes in emergency medicine.