Cast versus removable orthosis for the management of stable type B ankle fractures: a systematic review and meta-analysis

Abstract

Purpose There is currently no consensus on nonoperative management in adult patients after a stable type B ankle fracture. The aim of this review is to compare a removable orthosis versus a cast regarding safety and functional outcome in the NOM of stable type B ankle fractures. Methods A systematic review and meta-analysis were performed using randomized clinical trials and observational studies. The methodological quality of the included studies was assessed with the methodological index for non-randomized studies instrument. Nonoperative management was compared using the number of complications and functional outcome measured using the Olerud and Molander Score (OMAS) or the American Academy of Orthopaedic Surgeons Ankle Score. Results Five studies were included. Two were randomized clinical trials, and three were observational studies, including a total of 516 patients. A meta-analysis showed statistically significant higher odds of developing complications in the cast group [odds ratio (OR), 4.67 (95% confidence interval (CI) 1.52–14.35)]. Functional outcome in OMAS did not vary significantly at 6 weeks, mean difference (MD) − 6.64 (95% CI − 13.72 to + 0.45), and at 12 weeks, MD − 6.91 (95% CI − 18.73 to + 4.91). The mean difference of functional outcome in OMAS at 26 weeks or longer was significantly better in the removable orthosis group; MD − 2.63 (95% CI − 5.01 to − 0.25). Conclusion Results of this systematic review and meta-analysis show that a removable orthosis is a safe alternative type of NOM, as complication numbers are significantly lower in the orthosis group. In addition, no statistically significant differences were found in terms of functional outcome between a removable orthosis and a cast at 6 and 12 weeks. The 6-week and the 26-week OMAS results show that in patients with stable type B ankle fractures, a removable orthosis is non-inferior to a cast in terms of functional outcome.

Prospective randomized controlled trial: early weight bearing after conservative treatment of Weber B ankle fractures (pancake trial)

“…This study is not the first to compare mobilization and weightbearing to immobilization and non-weightbearing [ 8 , 13 , 15 , 17 ]. Most recent studies investigating alternative treatment options in stable type B ankle fractures compare functional bracing to casting, demonstrating functional bracing to be non-inferior to casting [ 13 , 15 ].…”

“…Only when syndesmotic and associated deltoid ligament injuries are ruled out, conservative treatment including weightbearing can be considered in this type of fracture. Although many already agree on the conservative treatment of stable Weber B fractures (AO type 44B1.1 and 44B1.2 fractures), using orthoses, the Arbeitsgemeinschaft für Osteosynthesefragen (AO) guidelines still suggest immobilization in an above-the-knee cast for 4–6 weeks [ 6 – 8 ].…”

Percutaneous Intramedullary Fixation of Distal Fibular Fractures

“…other hand, the current gold standard for treating unstable fractures is open reduction and internal fixation (ORIF) using screws and plates (4). Minimally invasive methods, such as intramedullary fixation, have been developed in response to concerns over serious wound consequences.…”