Improving Compliance With the British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) Guidelines for Early Weight Bearing Following Ankle Fracture Fixation: A Closed-Loop Audit From a UK District General Hospital

Background Ankle fractures are common injuries, and in many cases, operative treatment is required. While the indications for surgical fixation are well established, the optimal timing for weight bearing after open reduction and internal fixation (ORIF) remains controversial. Some surgeons continue to favour a conservative approach involving delayed weight bearing, whereas others encourage early mobilisation. The recent guidelines recommend early weight bearing unless there is a documented concern regarding fixation stability or soft tissue condition. Adherence to these guidelines promotes patient satisfaction and reduces strain on healthcare services. This closed-loop audit aimed to compare our department's practice at Royal Cornwall Hospital against the British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) standard for postoperative mobilisation after ankle fracture fixation. Methods This closed-loop audit involved both retrospective and prospective analysis of postoperative weight-bearing status in patients undergoing ORIF for isolated, closed ankle fractures at a single UK centre. Two audit cycles were performed. The first cycle (November 2023 to May 2024) retrospectively analysed patients' postoperative instructions. Following an educational intervention, including departmental emails and posters, a second cycle was prospectively conducted between July and November 2024. Inclusion criteria included skeletally mature patients (>18 years old) who underwent surgical treatment for isolated, closed ankle fractures. Exclusion criteria included open fractures, associated injuries, conservative management, or treatment with hindfoot nails. Results In the first cycle, 112 patients met the inclusion criteria. Of these, 56 patients (50%) were advised against early weight bearing, while 56 patients (50%) were advised to commence early weight bearing in a cast or boot. In the second cycle, 58 patients were assessed; 18 patients (31%) were advised against early weight bearing, and 40 patients (69%) were advised to commence early weight bearing, indicating significant improvement following intervention. Conclusion A targeted educational approach, including the distribution of BOAST guidelines and departmental discussions, led to improved compliance with early weight-bearing protocols. This audit highlights the value of team-based education and proactive audit cycles in enhancing adherence to national standards and improving service provision.