References

Patient-reported outcomes and prognostic factors in ankle fracture-dislocations: a systematic review. 2021. https//online.boneandjoint.org.uk/doi/abs/10.1302/1358-992X.2021.16.063

Bielska IA, Wang X, Lee R, Johnson AP. The health economics of ankle and foot sprains and fractures: a systematic review of English-language published papers. Part 2: the direct and indirect costs of injury. Foot (Edinb). 2019; 39:115-121 https://doi.org/10.1016/j.foot.2017.07.003

Braun V, Clarke V. Successful qualitative research.London: Sage; 2013

British Orthopaedic Association. British Orthopaedic Association standards for trauma and orthopaedics (BOASts). The management of ankle fractures. 2016. https//www.boa.ac.uk/standards-guidance/boasts.html (accessed 13 March 2024)

Dean DB. Field management of displaced ankle fractures: techniques for successful reduction. Wilderness Environ Med. 2009; 20:(1)57-60 https://doi.org/10.1580/08-WEME-CON-240.1

Deasy C, Murphy D, McMahon GC, Kelly IP. Ankle fractures: emergency department management… is there room for improvement?. Eur J Emerg Med. 2005; 12:(5)216-219 https://doi.org/10.1097/00063110-200510000-00003

Elsayed H, Thalava R, Afifi H, Khan M. Open ankle dislocation without associated malleolar fracture: review of the literature. Trauma Case Rep. 2017; 8:20-23 https://doi.org/10.1016/j.tcr.2017.01.015

Fonkoue L, Sarr L, Muluem KO Early posttraumatic ankle osteoarthritis following ankle fracture-dislocations in a sub-Saharan African setting. Orthop Traumatol Surg Res. 2021; 107:(6) https://doi.org/10.1016/j.otsr.2021.102996

Godoy-Santos AL, Schepers T Soft-tissue injury to the foot and ankle: literature review and staged management protocol. Acta Ortop Bras. 2019; 27:(4)223-229 https://doi.org/10.1590/1413-785220192704221240

Halm JA, Rammelt S, Schepers T. Complex injuries of the foot and ankle: early and definite management (article in English and German). Fuß & Sprunggelenk. 2021; 19:(4)196-205 https://doi.org/10.1016/j.fuspru.2021.09.002

Hennink M, Kaiser BN. Sample sizes for saturation in qualitative research: a systematic review of empirical tests. Soc Sci Med. 2022; 292 https://doi.org/10.1016/j.socscimed.2021.114523

Jootun D, McGhee G, Marland GR. Reflexivity: promoting rigour in qualitative research. Nurs Stand. 2009; 23:(23)42-46 https://doi.org/10.7748/ns2009.02.23.23.42.c6800

Lawson KA, Ayala AE, Morin ML, Latt LD, Wild JR. Ankle fracture-dislocations: a review. Foot Ankle Orthop. 2018; 3:(3) https://doi.org/10.1177/2473011418765122

McPhail SM, Dunstan J, Canning J, Haines TP. Life impact of ankle fractures: qualitative analysis of patient and clinician experiences. BMC Musculoskelet Disord. 2012; 13 https://doi.org/10.1186/1471-2474-13-224

Mehta SS, Rees K, Cutler L, Mangwani J. Understanding risks and complications in the management of ankle fractures. Indian J Orthop. 2014; 48:(5)445-452 https://doi.org/10.4103/0019-5413.139829

Mercer D, Haddon A, Loughlin C. Leading on the edge: the nature of paramedic leadership at the front line of care. Health Care Manage Rev. 2018; 43:(1)12-20 https://doi.org/10.1097/HMR.0000000000000125

Shen MS, Dodd AC, Lakomkin N Open treatment of ankle fracture as inpatient increases risk of complication. J Orthop Traumatol. 2017; 18:(4)431-438 https://doi.org/10.1007/s10195-017-0472-9

Siebenbürger G, Zeckey C, Fürmetz J, Ockert B, Böcker W, Helfen T. Medical speciality, medication or skills: key factors of prehospital joint reduction. A prospective, multicenter cohort study. Eur J Trauma Emerg Surg. 2018; 44:(4)637-642 https://doi.org/10.1007/s00068-018-0933-8

Simske NM, Audet MA, Kim CY, Vallier HA. Open ankle fractures are associated with complications and reoperations. OTA Int. 2019; 2:(4) https://doi.org/10.1097/OI9.0000000000000042

Smith L, Boyle M. Management of ankle injuries in the prehospital environment: a review of the literature. Australasian Journal of Paramedicine. 2013; https://doi.org/10.33151/ajp.10.1.45

Acute compartment syndrome. 2023. https//www.ncbi.nlm.nih.gov/books/NBK448124/

Troyer L, Brady W. Barriers to effective EMS to emergency department information transfer at patient handover: a systematic review. Am J Emerg Med. 2020; 38:(7)1494-1503 https://doi.org/10.1016/j.ajem.2020.04.036

Veldman FJ, Aldous CM, Smith ID, Rollinson PD. The importance of anatomical reduction in the functional outcome of open ankle fractures. J Orthop. 2020; 21:166-170 https://doi.org/10.1016/j.jor.2020.03.005

Wight L, Owen D, Goldbloom D, Knupp M. Pure ankle dislocation: a systematic review of the literature and estimation of incidence. Injury. 2017; 48:(10)2027-2034 https://doi.org/10.1016/j.injury.2017.08.011

Won Y, Lee GS, Hwang JM, Park IY, Song JH, Kang C, Hwang DS. Improved functional outcome after early reduction in Bosworth fracture-dislocation. Foot Ankle Surg. 2019; 25:(6)798-803 https://doi.org/10.1016/j.fas.2018.10.007

Research

Support from advanced practitioners in critical care for ankle fracture dislocation

02 April 2024
Research
02 April 2024
Volume 16 · Issue 4

Abstract

Background:

Analgesic imitations, under-recognition of injury severity and delayed restoration of neutral alignment are common problems around ankle fracture dislocation (AFD). Optimal prehospital management improves long-term outcomes.

Aims:

This study aimed to explore ambulance clinicians' experiences of AFD incidents when supported by advanced practitioners in critical care (APCCs).

Methods:

Semi-structured online interviews were conducted. Data sets were coded and grouped to identify themes via thematic content analysis.

Findings:

Six clinicians agreed to take part (response rate 42%). AFDs were encountered infrequently (once per year). Four themes were identified: clinicians' confidence in managing AFD; value-added role of APCCs; prehospital challenges; and reflections on the incident.

Conclusions:

Benefits of the APCC role include enhanced technical skills, including in ankle reduction and analgesia, and in non-technical skills, such as leadership and decision-making. Improvements in clinician recognition and management of AFD and better awareness of the APCC role are recommended, as is research on optimal prehospital AFD management.

Ankle fractures are common in adults in high-income countries (Wight et al, 2017). They typically occur in men due to their increased likelihood of trauma (Simske et al, 2019; Mehta et al, 2014) and in women predominantly from falls in their advancing age (Elsayed et al, 2017; Shen et al, 2017; Wire et al, 2024). Ankle injuries involving joint dislocation may present without fracture or, more commonly, as an ankle fracture dislocation (AFD) (Wight et al, 2017; Lawson et al, 2018).

Deformity, compromising skin integrity and circulation, is associated with AFDs (Lawson et al, 2018) and they have poorer outcomes than isolated ankle fractures, especially if the injury is unrecognised (Ahmed et al, 2021; Frank et al, 2023). The risks of amputation and mortality are greater for elderly patients with AFD (Mehta et al, 2014), and younger patients risk developing post-traumatic osteoarthritis, which affects quality of life with disability, pain and reduced function (Lawson et al, 2018; Wire et al, 2023). Long-term health, social care and productivity costs for these groups have significant economic consequences for healthcare and society (Bielska et al, 2019).

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Ankle fracture
Ankle reduction