301 Weight Bear That Ankle ASAP

Background

BOAST guidelines suggest that most patients should be advised to weight bear as tolerated, immediately after surgery, in a splint or cast unless there are specific concerns about the stability of the fixation or any contraindications.

The purpose of this audit is to determine the weight-bearing practice of surgically managed ankle fractures. Secondarily we aimed to assess whether a reduction in time to weight-bear would impact patient outcomes.

Method

Sixty-one surgically managed ankle fractures were included (35 retrospectively between March 2021 - September 2021 and 26 prospectively between March 2022 - July 2022).

Intervention after primary data analysis included the presentation of audit findings in T&O MDT meeting. The foot and Ankle consultant body encouraged the department to weight-bear patients as soon as possible post-operatively.

Results

There was a significant (p = 0.0072) reduction in the time-to-weight-bear between cycle 1 (39.7 ±15.2 days) and cycle 2 (27.3 ±19.7 days).

After intervention, 22% more people were weight-bearing before 14 days (ie. a significant increase from 8.6% to 30.8%; p = 0.025). This was not associated with an increased incidence of complications.

64.3% of all post-operative complications occurred in patients’ weight-bearing only after 6 weeks. There was no increase in complications if patients weight bear before the traditional '6 week' rule (p = 0.11). The presence of pre-operative risk factors was significantly associated with an increase in complication rates (p = 0.017).

Conclusions

This audit suggests reducing the time-to-weight-bear in patients with surgically managed ankle fractures is safe and does not result in worse patient outcomes.