Survey of management of ankle fracture blisters in Yorkshire among orthopaedic surgeons

Abstract

Introduction

The management of ankle fracture blisters is contentious. This study aims to evaluate the management of ankle fracture blisters among orthopedic surgeons in Yorkshire and establish a consensus.

Methods

A questionnaire was distributed among Orthopaedic Surgeons in Yorkshire, United Kingdom, to gain insight into their management of ankle fracture blisters. Responses were processed in Excel spreadsheet, chi-squared analysis was done, comparing the responses of foot and ankle surgeons with other orthopaedic surgeons.

Results

There were 69 respondents (58 % of whom were consultants, 7 % associate specialists and 35 % registrars) out of 125 surgeons invited to participate (55.2 % response rate). 17 were foot and ankle surgeons. For most respondents, the type of blister (haemorrhagic or serosanguinous) does not affect decision around timing of surgery. 76 % say that blister location affects the placement of skin incision. 19 % would make their skin incisions irrespective of blister location and 5 % had variable responses to this. 43 surgeons would defer the surgical fixation of the fracture if the blister were at the incision site, while 22 (32 %) would defer surgery if blister is extensive, but not as incision site. If surgery is deferred because of the blister, 52 % will wait till skin creases return while others would wait a variable period. While waiting, 67 % would immobilize with a plaster cast if appropriate, 56 % would use an external fixator. 65 % think that blisters increase the risk of infection, however, 97 % will not prescribe any systemic antibiotics for ankle fracture blisters. The most preferred dressing for blisters is Inadine and Mepitel.

Conclusion

Majority of Orthopaedic Surgeons in Yorkshire consider ankle fracture blisters to be significant in determining the management of patients with ankle fractures; however significantly more foot and ankle surgeons opine that blisters should not cause delay in definitive fixation of ankle fractures.