Purpose: Identifying optimal treatment strategies in patients with traumatic foot and ankle injuries has been hampered by the variety of different measurement tools and lack of validation of generic and foot-specific functional measures. It remains plausible that the choice of functional outcome measure may influence our ability to accurately measure treatment effects. This prospective observational study aims to correlate the scores across six functional outcome measures in patients with traumatic foot and ankle injuries and to examine agreement of scores and patients’ subjective health status.

Method: Patients with traumatic foot or ankle injuries completed two generic, the SF-12 Health Survey and the Short Musculoskeletal Functional Assessment (SMFA), and four specific health outcome measures, the Foot Function Index (FFI), Foot and Ankle Ability Measure (FAAM), American Academy of Orthopedic Surgeons (AAOS) Foot and Ankle Questionnaire and the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, at a single follow-up visit. Raw scores were calculated and used to assign patients to a categorical functional level (excellent, very good, good, fair or poor). Agreement between the assignments was assessed and Pearson correlation co-efficients were calculated for each pair of outcome scores. Statistical significance was determined using an α of 0.05.

Results: 52 patients (mean age 43.3 ± 16.8 years) were enrolled at a mean follow-up of 15.5 months. All correlations except for that between the AOFAS ankle-hindfoot scale and the mental component of the SF-12 were statistically significant. The strongest correlations were found between the SMFA, FFI, AAOS Foot and Ankle Questionnaire and the FAAM. Despite significant correlation between scores and patients’ subjective functional outcome, there was minimal agreement between assigned categorical functional levels.

Conclusion: The high correlations between scores on the generic and foot-specific functional measures suggest that it is likely unnecessary to use more than one instrument when examining functional outcome in patients with traumatic foot and ankle injuries. Generic tools also appear to function as well as specific scores in this population. However, assignment of patients to a categorical functional level based on raw outcome scores must be performed with caution as the results obtained may not accurately reflect functional outcome.

Proximal femoral fractures affect around 60 000 patients annually in the UK. A delay in excess of 48 hours from admission to theatre has been shown to have an adverse effect on mortality, morbidity and length of inpatient stay in this patient group (Hollingworth 1993). We set out to identify the causes and effects of any delay to theatre and make suggestions in order to improve the quality and efficiency of our service.

We tracked 224 consecutive patients all admitted with a proximal femoral fracture over an eight month period. We recorded a number of details including whether or not a delay occurred and why, on a session-by-session basis.

Of the 214 patients included, 75.7% were considered fit enough for surgery at admission; 83.2% of these suffered some sort of delay to theatre. Only 5.6% of patients (8 in total) were considered fit enough for surgery at admission, suffered a delay to theatre and subsequently became unfit causing a further delay.

We were reassured to find that our patients are not suffering a longer than average delay to theatre and that those patients who were waiting longer were not becoming ill as a result. We also found that patients admitted on certain days of the week seemed to wait longer, indicating that certain sub-specialty elective lists were taking up theatre time and exacerbating the delay. We have suggested changes to the theatre rota in order to maximise efficiency and aim to repeat this audit to evaluate the effect of these changes.