Just 3 Weeks in a Cast Enough to Heal Your Ankle Fracture

Highlights:

Wearing a cast for three weeks is as good as wearing it for six-weeks for healing ankle fractures
For stable ankle fractures, not requiring surgery, shorter immobilization times are not only convenient but also heal faster than conventional strategies
This can save time, money and productivity for doctors and patients

Wearing a cast for three weeks may be as good as wearing it for the usual six weeks for healing ankle fractures, reveals new research from Finland. The study finds that the most common type of ankle fracture (Weber B-type) heals equally well when the cast is worn for just three weeks compared to six.

This is the first study that provides high-quality evidence for using a cast for a shorter period of time than the conventional time-period of six weeks. This finding has been highly appreciated by doctors and patients alike, as this strategy is not only convenient and time-saving but also because long-term use of casts can cause complications such as stiffness, blocked blood vessels and skin damage.

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Bimalleolar Fracture
Bimalleolar fractures occur when there is a break at the lower ends of the fibula and tibia at the ankle.

‘Wearing a cast for three weeks is as good as wearing it for six for healing ankle fractures. In case of stable ankle fractures that do not require surgery, shorter immobilization periods are not only more convenient but can also heal faster than conventional approaches.’
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The research findings have been published in the British Medical Journal (BMJ), a journal of the BMJ Publishing Group Ltd., UK.

Key Features

The following are the key features of the study:

This was a randomized, multicenter, non-inferiority clinical trial that was carried out for a period of four years (2012-2016)
The study was conducted at two major hospitals in Finland - the Oulu University Hospital and the Tampere University Hospital
The study included 247 participants, all above 16 years of age with the average age being 45 years
Approximately half (51%) of the participants were male
All the study participants had sustained stable ankle fractures (fractures not requiring surgery), which were confirmed by the external-rotation (ER) stress test
Participants were randomly allocated to one of the following three treatment groups:

Six-week cast - 84 participants
Three-week cast - 83 participants
Three-week ankle brace - 80 participants

Follow-up was done at 6, 12 and 52 weeks to evaluate any ankle fracture symptoms
Ankle fracture symptoms were evaluated using Olerud-Molander Ankle Score (OMAS) - higher scores mean better healing
Other factors that were evaluated include the following:

Pain
Quality of life
Mobility of ankle
X-ray findings
Any negative effects of treatment experienced by the participants

Key Findings

The major findings are highlighted below:

The scheduled one-year follow-up revealed that the OMAS Scores of the three-week cast/brace groups were as good or even marginally better than the six-week group:

Three-week cast group - OMAS Score: 91.7
Three-week brace group - OMAS Score: 89.8
Six-week cast group - OMAS Score: 87.6

Slightly better improvement in ankle mobility was observed in the three-week ankle brace group, compared to the six-week cast group.

Study Limitation

A limitation of the study is that the findings may not be generalizable as unmeasured factors may have had an influence on the outcome. However, the authors indicate that most of these confounding factors were taken into consideration while analyzing the data.

Concluding Remarks

The study findings indicate that the most common type of stable ankle fracture (Weber B-type) heals just as well in a cast worn for three weeks, as compared to that worn for six weeks.

The authors conclude: "With stable ankle fractures not requiring surgery, shorter and more convenient strategies could result in successful fracture healing."

Funding Source

The study was funded by Oulu University Hospital and Tampere University Hospital, Finland.

Reference :

Three Week Versus Six Week Immobilization for Stable Weber B Type Ankle Fractures: Randomized, Multicenter, Non-inferiority Clinical Trial - (https://doi.org/10.1136/bmj.k5432)

Source: Medindia

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Trimalleolar Fracture
Trimalleolar fracture is the fracture of the ankle involving three bones in the lower leg, namely medial malleolus, lateral malleolus, and the posterior part of the tibial bone.