ANALYSIS OF THE APPROACH TO ANKLE FRACTURES REQUIRING OPERATIVE INTERVENTION IN THE REPUBLIC OF IRELAND OVER AN EIGHT-YEAR PERIOD

Abstract

Note: No previous similar study to this has been carried out in the Republic of Ireland, to our knowledge. Ankle fractures are the most common lower limb fracture in all age groups in Ireland. Approximately 43% of all ankle fractures will require operative fixation.¹ 82% of all operative ankle procedures in Ireland are carried out on patients between 18–65 years old.

We felt it was imperative to study the incidence within various age groups, the associated length of hospital stay and to offer suggestions in reducing this length-of-stay.

The National Hospital Inpatient Enquiry system (data collection accuracy 95.9%–98.2%), ICD-coding and data from the Central Statistics Office were analysed.²

14,903 ankle fractures underwent ORIF between 2002–09 (average 1,928/year). While there was a statistical increase in ORIF's in the over 65 group, there was no overall increase in the incidence of surgical procedures.

The average length-of-stay in 2002 was 4.8 days, but had significantly dropped to 4.0 days by 2009. This was most marked in the over 65's where it decreased from 10.5 to 7.7 days.

The annual incidence of ankle fractures requiring operative intervention in Ireland was 44.43 per 100,000 persons.

This study highlights many issues, namely:

1. a)

   While there is a significant decrease in length-of-stay to 4 days, we feel this figure could be significantly reduced further.

2. b)

   While the incidence of ankle fractures in the over-65 group remained stable, surprisingly there was a statistically significant increase in the number of operative procedures within this age group.