999 Management of Ankle Fractures in Compliance with the British Orthopaedic Association Standards for Trauma (BOAST) Guidance

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Abstract Aim Ankle fractures account for 9% of Emergency Department fractures, representing a significant trauma workload. Early assessment, stabilisation, and evidence-based management are essential. The British Orthopaedic Association Standards for Trauma (BOAST) guide assessment, imaging, reduction, fixation, and post-management care. This audit evaluated departmental compliance with BOAST guidelines. Method A retrospective audit included patients presenting with ankle fractures between January and June 2024, identified via Virtual Fracture Clinic records and trauma meeting lists. Data from TrakCare (clinical notes and letters) were reviewed. Compliance was assessed for mechanism of injury (MOI), skin and neurovascular (NV) status, comorbidities, imaging, manipulation and immobilisation, post-reduction NV assessment, post-reduction imaging, surgery timing, weight-bearing advice, and VTE prophylaxis. Descriptive statistics were applied. Results 202 patients were included; 48(23.8%) underwent operative management (44 ORIF, 4 external fixation). MOI was documented in 99%, NV status in 83%, skin assessment in 11%, and comorbidities in 66%. Manipulation in A&E occurred in 55%; casts and pre-reduction radiographs were available in all. Post-reduction NV checks were documented in 60% of manipulated cases, and post-reduction X-rays in 67%. Early fixation on the day of injury occurred in 22% (<60 years) and 21% (≥60 years); average delay was 5–6 days due to swelling, theatre availability, clinical instability, delayed presentation, or initial conservative management. 89% were advised non-weight-bearing. VTE prophylaxis was given in 84%. Conclusions Compliance with BOAST standards is variable. Major deficiencies include poor post-manipulation NV documentation, missing post-reduction X-rays, and limited early surgical fixation. Structured clerking, standardised documentation, and optimised theatre access are recommended.

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