Treating ankle fractures is a standard teaching procedure for surgical residents due to the high incidence and standardised treatment. Apart from the aspect of centralisation, teaching has an important influence on outcome. In this context, there is a lack of valid data to compare the outcome of malleolar fractures between high-volume centres (HVCs) and low-volume centres (LVCs). However, the implementation of centralisation and its extension to less highly specialised treatments has not yet been conclusively resolved in the medical community. This debate is being driven forward not only by medical aspects but also by economic and political considerations. Currently, there is both political and social debate about the need for centralisation in other areas of medical care. Therefore, ankle fractures are ideal for research purposes.Ĭentralisation is already state of the art in highly specialised medical disciplines and has become entrenched by improving care and enhancing treatment outcomes. Because of this high incidence, ankle fractures are not only a relevant medical topic but also one that requires attention from an economic point of view. They account for 10–12% of all fractures. No difference in mortality could be detected.Īnkle fractures are common with an incidence of 122 to 187 per 100,000 population and account for the majority of foot and ankle injuries. However, structural and organisational differences, such as an extended preoperative stays at HVCs and a higher teaching rate, were also apparent. These differences could be explained due to a more severely ill patient population and more complex (also open) fracture patterns with resulting use of external fixation and longer duration of surgery. We found significant differences between HVCs and LVCs in terms of in-hospital outcomes for ankle fractures. Teaching status had no influence on mortality or complications but was associated with a prolonged length of stay and operating time. The frequency of teaching operations was significantly higher at HVCs (30% vs. In addition, a higher rate of complications of 3.2% was found at HVCs compared to 1.9% at LVCs. A longer hospitalisation of 7.2 ± 5 days at HVCs vs. There was no difference in mortality between treatment at HVCs and LVCs. A more frequent use of external fixation (2.5% vs. Open reduction and internal fixation was the most common operative treatment at HVCs and LVCs (95% vs. 19%) and had more open fractures (0.48% vs. 50 years old), had more comorbidities (26% vs. By dividing the total cases arbitrarily in half, 12 HVCs ( n = 3327, 49%) and 56 LVCs ( n = 3433, 51%) were identified. Variables were sought in bivariate and multivariate analyses. Inclusion criteria were isolated, and operatively treated lateral malleolar fractures (ICD-10 Code S82.6 and corresponding procedure codes). MethodsĪ retrospective analysis of malleolar fractures recorded in a National Quality Assurance Database (AQC) from the period 01-01-1998 to 31-12-2018 was carried out. In light of current discussions about centralisation and teaching in medicine, we wanted to investigate the differences in in-hospital outcomes after surgical treatment of isolated ankle fractures, taking into account high-volume centres (HVCs) and low-volume centres (LVCs) and teaching procedures.
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