Background: Over many years our understanding of fracture patterns and management has evolved. One of the biggest steps was the adoption of the principles of fracture fixation as described by the Arbitsgemeinschaft fur Osteosynthesefragen (AO). The application of this philosophy has allowed us to optimise fracture management and improve outcome.

In our unit we noted a number of complications resulting from suboptimal fracture fixations of ankles some of which required revision. It was decided to review fracture fixation of ankles in the unit to see whether the basic principles of fixation was being followed in our DGH.

Aim: To evaluate whether the AO principles of fixation for ankle fractures are being followed in our local unit.

Patients and Methods: 52 consecutive patients over a period of 1 year from August 2005 to August 2006 with bi malleolar and isolated medial malleolar ankle fractures, requiring surgery, had their case notes and pre operative x rays reviewed retrospectively looking at fracture patterns according to the AO and Weber classification. Post operative x rays where reviewed to see if the principles of facture fixation had been appropriately followed.

Results: Of the 52 patients evaluated 26 were Weber type B fractures, 20 were type C and 6 were isolated medial malleolar fracture. Nine of the type B and three of type C (23% of the total number) underwent fixation not in accordance with AO principles.

In every case the fibula fixation did not include a cortical lag screw.

Discussion/Conclusions: Although none of the 12 described had to undergo revision, their management was far from optimum.

By ensuring that operating surgeons have the appropriate training and experience in basic fracture fixation before being allowed to undertake such procedures, our unit hopes to show an improvement on these figures by the time this audit is repeated.