Abstract
IntroductionAnkle fractures have traditionally been seen as low priority cases as they do not pose an immediate life threat. Ankle fractures have the potential to create long-term mobility consequences for a person if managed inappropriately. The objective of this study was to determine the most effective way to manage ankle injuries in the prehospital environment.
MethodsA literature search was conducted of the medical related electronic databases, Ovid preMedline, Medline, Cinahl, Cochrane CENTRAL, and EMBASE from 1980 to the end of May 2013. A previously published prehospital search filter was used in each of the databases including additional keywords “fracture”, “ankle”, “ankle injuries”, “bone fractures”, and “sprains and strains”. Articles were included if their primary aim was to examine the appropriate management of ankle fractures in the prehospital environment. The references of retrieved articles were also reviewed. Articles were excluded if they were not written in English.
ResultsThere were 531 articles located in the search. After reviewing the articles three were determined to meet the inclusion criteria. One article was set primarily in the emergency department but also included prehospital management. The remaining two articles were set in the prehospital setting. The findings suggest there is a defined set of questions to ask and specific assessment criteria for a patient with an ankle injury to determine its potential severity. Where there is neurovascular compromise anatomical realignment should be attempted.
ConclusionA thorough initial assessment and good basic management by prehospital care providers is essential to assist in decreasing delays to definitive treatment for patients with suspected ankle fractures, dislocations or fracture/dislocations. Further research is needed to determine to most effective management strategies in order to achieve optimal outcomes for patients with ankle injuries.
References
Archer F, Woollard M, Snooks H, Evans A, Wells B, Peconi J, et al. What are the highest priorities for research in prehospital care? Results of a review and Delphi Consultation exercise - Executive Summary. Journal of Emergency Primary Health Care. 2008;6(4).
Lash N, Horne G, Fielden J, Devane P. Ankle fractures: functional and lifestyle outcome at 2 years. ANZ J Surg. 2002;72(10):714-30.
Lin CC, Moseley AM, Refshuage KM, Haas M, Herbert RD. Effectiveness of joint mobilisation after cast immobilisation for ankle fracture: a protocol for a randomised controlled trial. BMC Musculoskelet Disord. 2006;7:46.
Deasy C, Murphy D, McMahon GC, Kelly IP. Ankle fractures: emergency department management… Is there room for improvement? J Emerg Med. 2005;12:216-9.
Court-Brown CM, McBirnie J, Wilson G. Adult ankle fractures- an increasing problem? Acta Orthop Scand. 1998;69(1):43-7.
Jensen SL, Andresen BK, Mencke S, Nielsen PT. Epidemiology of ankle fractures: a prospective population-based study of 212 cases in Aalborg, Denmark. Acta Orthop Scand. 1998;69:48-50.
Fong DT, Hong Y, Chan LK, Yung PS, Chan KM. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37:73-94.
Dean B. Field Management of Displaced Ankle Fractures: Techniques for Successful Reduction. Wilderness Environ Med. 2009;20(1):57-60.
Payne R, Kinmont JC, Moalypour SM. Initial management of closed fracture-dislocations of the ankle. Ann R Coll Surg Engl. 2004;86:177-81.
Lee C, Porter KM. Prehospital management of lower limb fractures. Emerg Med J. 2005;22:660-3.
Smith E, Archer F, Burgess S. The development of an updated prehospital search filter for the Cochrane Library: Prehospital Search Filter Version 2.0. Journal of Emergency Primary Health Care. 2010;8(4).
Watson JAS, Hollingdale JP. Early management of displaced ankle fractures. Injury. 1992;23(2):87-8.
Larsen D. Assessment and management of foot and ankle fractures. Nurs Stand. 2002;17(6):37-46.
van den Bekerom MPJ, Struijs PAA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GMMJ. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? J Athlet Train. 2012;47(4):435-43.
Stiell IG, McKnight RD, Greenberg GH, McDowell I, Nair RC, Wells GA, et al. Implementation of the Ottawa ankle rules. JAMA. 1994;271(11):827-32.
Simpson P. Use of the Ottawa Ankle Rule by paramedics in the out-of-hospital setting. Journal of Emergency Primary Health Care. 2010;8(2).