Demographics of 3929 ankle injuries, seasonal variation in diagnosis and more fractures are diagnosed in winter

IntroductionAn audit took place to look at the diagnostic or pick-up rate of ankle fractures. A seasonal variation was discovered. Although it is expected that more fractures may be seen in wet or icy periods, an excess of X-rays taken in the summer months has not been previously registered.MethodAn automated X-ray system was looked at to see the number of X-rays taken and the diagnostic yield.ResultsWe reviewed ankle X-rays of 3929 patients over a 24-month period between 1 July 2009 and 31 June 2011; of which, 612 patients were found to have fractured their ankle giving a pick-up rate of 0.16. This is less than what might be expected with strict application of Ottawa rules. The pick-up rate fluctuated each month from an admirable 0.35 fractures per X-ray ordered in December 2009 to a lowly 0.06 fractures per X-ray in May 2010. The same pattern was noted for the other year. For both Decembers, the fewest number of X-rays were taken at 80 and 140, the most at 200 and 240 in May for both years. Less X-rays were taken in for all winter months. For younger age groups, males dominated with the crossover to females dominating in the fifth decade.ConclusionWe postulate that summertime sports and recreational injuries may cause less fractures than at winter periods but result in more X-rays taken. We have reviewed our practice to try to improve our diagnostic rates; the basic tenets of Ottawa rules including the presence of bony tenderness and weight-bearing status have been reinforced in our teaching sessions. It is highly likely that strict application of these methods will decrease the number of X-rays taken and improve our pick-up rates.