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Functional bracing treatment for stable type B ankle fractures
van den Berg C, Haak T, Weil NL, Hoogendoorn JM
Injury 2018 Aug;49(8):1607-1611
clinical trial
4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: No. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: In general, stable type B ankle fractures are treated conservatively with cast immobilization or a walking boot during six weeks. Some disadvantages of casting are joint stiffness, muscle wasting and lack of comfort. This study was designed to evaluate whether functional treatment with a removable brace is a safe and more comfortable alternative. MATERIAL AND METHODS: Randomized controlled trial. In the period March 2013 to May 2015, 44 patients visiting the emergency department due to a stable type B ankle fracture were included. During the first week both groups received a splint. After one week the patients were randomized: one group received a cast, the other a removable brace. For outcome Olerud and Molander Ankle Score, visual analogue score for comfort and pain, American Academy of Orthopaedic Surgeons (AAOS) Foot and Ankle score questionnaire, EuroQol-5D and range of motion were used. RESULTS: 44 patients participated (21 cast, 23 brace). There were no differences in baseline characteristics. After 6 weeks, VAS for comfort (cast versus brace 5.74 versus 7.21, p = 0.02) and total range of motion (40 degrees versus 49 degrees, p = 0.00) showed significant differences in favour of the brace. VAS pain (3.15 versus 2.05, p = 0.16), OMA-score (51.75 versus 61.32, p = 0.22) en EuroQoL-5D (7.26 versus 6.74, p = 0.33) did not show significant differences. Week 52 showed no significant differences at OMA-score (89.29 versus 96.18, p = 0.16), EuroQoL-5D (6.00 versus 5.35, p = 0.15), VAS pain (1.07 versus 0.82, p = 0.69) and AAOS score (91.71 versus 96.06, p = 0.21). No complications occurred in both groups. CONCLUSION: Functional bracing showed significant differences for the VAS comfort score and range of motion at 6 weeks compared to casting. After a year no significant differences were found. Treatment with a brace is a safe and more comfortable option for stable type B ankle fractures.
With permission from Excerpta Medica Inc.

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