Study suggests halving time in cast for ankle fractures

Wearing a cast or ankle support for three weeks is just as successful as the usual six weeks for healing ankle fractures, according to a study published in the British Medical Journal.

Recent studies have looked at different methods for non-operative treatment of fractures, but due to the lack of high-quality evidence, wearing a cast for six weeks remains the accepted treatment.

However, there are risks associated with prolonged immobilisation, including stiffness, skin damage and blocked blood vessels.

As a result, researchers in Finland investigated whether a shorter treatment period of three weeks could safely match the results of six weeks when treating the most common type of ankle fracture.

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The randomised controlled trial was conducted at two major trauma centres in Finland between 2012-2016, and included 247 participants aged 16 and above, with an average age of 45.

The participants were randomly allocated to a treatment group: 84 people had the conventional six week cast, 83 people spent three weeks in a cast, and 80 people wore a simple ankle brace for three weeks.

They had follow-up appointments at six, 12 and 52 weeks to measure ankle fracture symptoms using the Olerud-Molander Ankle Score (OMAS), where higher scores indicate better healing.

The researchers also assessed ankle function, pain, quality of life, ankle motion and x-ray results, and they looked at harms by asking the patients to describe any negative effects of the treatment.

At the year follow-up, the mean OMAS scores for the groups showed that the three week periods were no worse than the six weeks, with the three week cast and device groups scoring 91.7 and 89.8, respectively, compared with 87.6 in the six week group.

The researchers also noted a slight improvement in participants’ ankle mobility in the three week ankle brace group, compared with the six week group. No other significant difference was found between the groups with regard to harms.