Abstract
Purpose
Educational handouts designed for patients are promoted as a tool to educate, increase satisfaction, and potentially improve outcome. However, the value of these educational handouts as an adjunct to standard surgical care has not been formally assessed after ankle fracture. The purpose of this study was to compare standard post-operative care following surgically treated rotational ankle fracture to care supplemented with the use of adjunctive educational handouts.
Method
Fifty-one patients who sustained a rotational ankle fracture requiring open reduction and internal fixation were randomized to receive either standard care (group S) for an ankle fracture, or to additionally receive the AAOS handout on ankle fractures and a handout describing appropriate mobilization exercises (group H). Standard care included follow up visits at 2, 6, and 12 weeks postoperatively in a busy orthopaedic fracture clinic, including brief instructions on mobilization exercises. A bulky plaster-reinforced dressing was used for immobilization for the first two weeks following surgery, followed by a removable boot. Range of motion exercises were encouraged after the first two weeks and weight bearing was encouraged six weeks after surgery. Surgeons and outcome assessors were blinded to treatment group.
Patients completed functional outcome assessment (Olerud-Molander ankle score), objective measurement of ankle motion, and visual analog scale questions related to satisfaction at 6 and 12 weeks after surgery.
Results
The groups were equivalent with respect to fracture type, and complication rate. Three patients, all in group S, were lost to follow-up. Group H patients had higher satisfaction scores at 3 months (9.2 vs 6.3; p < 0.01). Group H patients demonstrated improvements in Work/Activity ability at 6 weeks (p=0.01), but this benefit was not sustained at 3 months (p =0.24). No differences in motion or other functional outcome scores were noted.
Conclusion
Educational handouts designed for patients can be helpful in providing patients with accessible information in the post-operative period. The use of an educational handout was a valuable tool to improve patient satisfaction, and may have the potential to improve outcome.
