A prospective study of 97 consecutive patients with inversion ankle injuries who were referred by their family practitioner to an accident and emergency department was carried out. Clinical features and resultant diagnosis were compared with 403 consecutive patients who referred themselves direct to the accident unit during the study period. There was no significant difference in the incidence of serious injuries between the two referral groups. Multivariate analysis of the combined referral groups revealed that age over 60 years, inability to weight-bear and distal fibular tenderness were critical diagnostic parameters and this result has been reported elsewhere. Further analysis of these features in each referral sub-group showed that significantly more patients referred by their family doctor were in the important over 60 years age group but that the incidence of the other diagnostic parameters were similar in the two populations. Using the presence of any one of these criteria as an indication for hospital referral with a view to X-ray examination, 70of the patients seen first by their own doctor did actually warrant radiography compared with 58in the self-referred group. However, it is apparent that more efficient hospital referral from family practice is possible by use of the clinical parameters described above and no serious fracture would have been missed by a general practitioner using such a policy in this population. Analysis of the reasons for referral by general practitioners is discussed and a suggested management regime is provided for all patients with inversion ankle injuries who attend their own doctor in the first instance.
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