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.
The research findings have been published in the British Medical Journal (BMJ)
, a journal of the BMJ Publishing Group Ltd., UK.
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:
- Quality of life
- Mobility of ankle
- X-ray findings
- Any negative effects of treatment experienced by the participants
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.
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.
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."
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)