Cast immobilization, removable bracing yield similar outcomes in ankle fractures

2021-12-27 20:45:49 By : Mr. xu jinping

Kearney RS, et al. Br Med J. 2021;doi:10.1136/bmj.n1506.

Kearney RS, et al. Br Med J. 2021;doi:10.1136/bmj.n1506.

Differences between traditional cast immobilization and removable bracing for treatment of ankle fractures in adults were not significantly different, according to recently published data.

Rebecca S. Kearney, PhD, and colleagues randomly assigned 669 adults with acute ankle fractures suitable for cast immobilization treatment with either a plaster cast (n = 334) or a removable brace (n = 335). Seventy-five percent of the participants completed the study.

The primary outcome was Olerud Molander ankle score collected at 16 weeks, which researchers analyzed by intention to treat. Secondary outcomes included the Manchester-Oxford foot questionnaire, disability rating index, quality of life and complications data collected at 6, 10 and 16 weeks.

The Olerud Molander ankle score did not show any statistically significant differences between the cast and removable brace groups at 16 weeks, according to the investigators. They also did not observe any clinically significant differences in the Olerud Molander ankle scores at other time points in the secondary unadjusted, imputed or per protocol analyses. Further, study results showed the disability rating index, Manchester-Oxford foot questionnaire or EuroQol-5D secondary outcomes did not have clinically relevant differences between the two groups at any time point.

“The research study showed that using a cast after a broken ankle was not better than using a boot after 4 months. The results were also the same when comparing those who received surgery and those who did not,” Kearney told Healio Orthopedics. “With cast not being better, it comes down to a decision on the cost of the interventions, patient preferences and if there’s a difference in complications, which we did not find evidence of. Patients should discuss their preference with their clinician, who should take into account these factors.”

Due to the large number of patients included in this study and the randomized controls, I found this study helpful and am confident in the results. In my opinion, for multiple reasons, the initiation of early range of motion is never a bad idea, especially if there is an acceptable anatomic reduction of the fracture and stable internal fixation in otherwise healthy individuals. 

Although the number of patients that developed deep venous thrombosis was equal in both groups, I do feel that early range motion is not detrimental when attempting to reduce the incidence of deep venous thrombosis. Also, I feel that early range of motion can help reduce the amount of muscle mass loss patients experience and help preserve muscle strength. In addition, I have found in my practice that patients are happier when they spend less time immobilized in a cast. This study confirms my thoughts on the matter.  

Based on the results of the Olerud Molander ankle score and comparing complications of the casting and removable splint groups found in this study, I will continue to initiate early range of motion exercises and utilize removable splints early on for ankle fracture patients whenever possible.

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