Impact of Timing Surgical Fixation on Complications and Functional Outcomes in Ankle Fractures

Introduction: This study aimed to assess whether adherence to the British Orthopaedic Association Standards for Trauma (BOAST) and National Institute for Health and Care Excellence (NICE) guidelines for ankle fractures is associated with reduced complication rates and improved functional outcomes. Methods: A retrospective analysis was conducted of all patients who underwent surgical fixation for ankle fractures in August 2023 to January 2024 from an acute hospital. Statistical analyses were performed using IBM SPSS Statistics software, version 29 (IBM Corp., Armonk, NY), to explore the relationship between BOAST and NICE guideline adherence and the study outcomes.

Results: The analysis revealed that only 10% of patients underwent ankle surgical fixation in accordance with the BOAST and NICE guidelines, with the mean time for surgery from injury as 10.7 days for the remaining cohort. Mental health effects were also recognised, with 26.7% due to waiting times. The association between BOAST and NICE compliance and complication incidence was found to be non-significant (p = 0.414). Mean Manchester-Oxford Foot Questionnaire (MOXFQ) scores were lower in the BOAST and NICE-compliant groups. The correlation coefficient between surgical waiting time and MOXFQ scores was r = 0.007, demonstrating no significant correlation between the time to surgery from injury and functional outcomes.

Conclusions: This study highlights the challenges in adhering to BOAST and NICE guidelines for timely surgical intervention in ankle fractures, with only a small proportion of patients receiving surgery within the recommended timeframe. Larger-scale studies are required to substantiate the hypothesis that early surgical intervention, as per the guidelines, leads to improved outcomes and whether achievement of the guidelines is feasible or requires re-examination.