Title : Adequacy of ankle radiographs lateral views in a trauma unit: A quality improvement project
Abstract:
Introduction: Ankle injuries are among the most common presentations in an acute orthopedic setting. Appropriate radiographic analysis of the ankle is of paramount importance from a diagnostic perspective. According to the British Orthopedic Association Standard for Trauma guidelines, radiographs should be centered on the ankle and include a true lateral for proper assessment. We assessed the adequacy of the true lateral radiograph films at our hospital in a closed loop audit.
Methods: To ascertain the adequacy of lateral views ankle radiographs taken in an acute setting in accordance with the standards for them being true lateral. Data was collected retrospectively for patients with ankle xrays done for suspected fractures, and the adequacy of the lateral radiograph was assessed on 4 parameters, namely; Criteria 1 (distal fibula should be superimposed by posterior aspect of distal tibia), Criteria 2 (talar domes should be superimposed), Criteria 3 (joint space between distal tibia and talus should be open and uniform), Criteria 4 (lateral ankle radiograph should include lower third of tibia and fibula, talus, base of 5th metatarsal and calcaneus). 2 cycles were conducted against these standards. Following the first cycle, gaps in practice were identified and an educational session was undertaken along with display of posters in clinical areas to improve awareness. A subsequent cycle was undertaken to evaluate effectiveness of aforementioned interventions. Target compliance was set to 100%. Patients <12 yrs, open fractures or those in casts or with previous ankle surgery met the exclusion criteria. The adequacy of radiographs against set standards was reviewed by a senior orthopedic registrar.
Results: 100 patient records were analyzed during the first and second cycles. For the first cycle, the compliance to each criterion was as follows; criteria 1 (83%), criteria 2 (61%), criteria 3 (69%) and criteria 4 (99%). Following the interventions after first cycle, a repeat cycle was conducted with similar number of patient records, which yielded the following results; criteria 1 (95%), criteria 2 (85%), criteria 3 (92%) and criteria 4 (99%).
Conclusion: Appropriateness of ankle radiographs, especially the true lateral view is an important diagnostic tool for the orthopedic doctor. Our quality improvement project demonstrates that simple educational measures to increase awareness amongst involved team members can significantly improve quality of radiographs.
