A Stability-Based Management Protocol for Isolated Lateral Malleolar Ankle Fractures at the Level of the Syndesmosis Reduces the Need for Surgical Intervention.

Purpose: The study aimed to establish and subsequently improve the rate of stability assessments of fractures with uncertain stability and the impact on the avoidance of potentially unnecessary surgery.

Methods: Two independent audit cycles were conducted from October 2019 to May 2020. All patients had closed isolated lateral malleolar fractures at the level of the tibiotalar syndesmosis involving skeletally mature bone. A stability-based management protocol was introduced, incorporating an education programme and management guideline.

Results: 75 ankles fractures were included. In the initial audit cycle, 13 patients did not undergo stability X-rays within 2 weeks of injury. Interestingly, only one stability assessment was performed for five operated ankles in the first audit, versus a 100% compliance rate in the second cycle. We observed more accurate documentation following education and awareness of clinical importance.

Conclusion: By implementing a stability-based management guideline, there was an improvement in compliance with guidance towards stability assessments of ankle fractures. This potentially led to the avoidance of unnecessary surgery on fractures where stability assessments supported non-operative management.