Interventions for treating ankle fractures in children

Yeung, Denise; Miller, Clare; Jia, Xueli; Barker, Simon

doi:10.1002/14651858.cd010836

Cochrane Database of Systematic Reviews 2013

DOI: 10.1002/14651858.cd010836

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Interventions for treating ankle fractures in children

Denise Yeung¹,

Clare Miller²,

Xueli Jia³

et al.

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Cited by 3 publications

(2 citation statements)

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“…In the recent Cochrane reviews of Pediatric Ankle Fractures, 3 studies discussed removable immobilization versus plaster or fiberglass casting for these injuries. [5][6][7][8] All 3 studies concluded that removable immobilization is more effective and results in faster recovery of physical function, greater family and patient satisfaction, and is less costly than traditional casting. [6][7][8] In each study, the use of crutches was part of the recommendation for the removable immobilization group.…”

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confidence: 99%

Controlled Ankle Movement (CAM) Boot Provides Improved Outcomes With Lower Complications Than Short Leg Walking Cast in Low-energy Pediatric Lateral Ankle Injuries: A Prospective, Randomized Study

Beck

Kang

Bennett

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Low-energy lateral ankle injuries (Salter-Harris 1 distal fibula, distal fibula avulsion fractures, and radiograph-negative lateral ankle injuries) are common in pediatric patients. Patient-based outcomes for the 2 treatment options, short leg walking cast (CAST) and controlled ankle motion (CAM) boot, are unknown. This study aims to determine differences between 2 treatments of low-energy lateral ankle injuries in pediatric patients. Methods: A prospective, randomized controlled trial comparing the acute outcomes of CAST and CAM treatment for low-energy lateral ankle injuries in pediatric patients was completed. Patients were evaluated in-person at presentation and 4 weeks for ankle range of motion and Oxford foot and ankle score. A novel survey defining patient and parent satisfaction and time away from school/work was also completed. Treatment complications were documented. Patients were called at 8 weeks postinjury to determine other complications and the final time of return to sport. Mixed effects linear regression models evaluated change over time between the 2 treatment groups. Results: After 60 patients were enrolled, 28 patients in the CAST group and 27 patients in the CAM group completed the study. Males comprised 51% (28), with 38 (69%) patients identifying as Hispanic. The patient’s average age was 11.3±2.9 years and the average body mass index was 23. At the 4-week evaluation, the CAM group had improved range of motion, higher satisfaction scores (5.26 CAM vs. 4.25 CAST, P<0.05), similar pain scores (0.32 CAST vs. 0.41 CAM, P=0.75), and lower complications (0.54/patient CAST vs. 0.04/patient CAM, P<0.0001) than the CAST group. Female patients had improved inversion with CAM treatment than males (P<0.05). Patients over age 12 in the CAST group had significantly decreased plantarflexion at week 4 (P=0.002). Improvement in Oxford scores was similar between the CAST and CAM groups between the initial presentation and 4 weeks, except for increased improvement in CAM group Oxford scores for difficulty running and symptoms with walking/walking. At the 8-week evaluation, patients in the CAST group had a higher rate of continued symptoms than the CAM group (15.4% vs. 0%) Conclusions: CAM boot treatment of low-energy lateral ankle injuries in pediatric patients results in improved results and lower complications than CAST treatment. Level of Evidence: Level I —randomized, controlled trial with a statistically significant difference.

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mentioning

confidence: 99%

Controlled Ankle Movement (CAM) Boot Provides Improved Outcomes With Lower Complications Than Short Leg Walking Cast in Low-energy Pediatric Lateral Ankle Injuries: A Prospective, Randomized Study

Beck

Kang

Bennett

et al. 2023

Journal of Pediatric Orthopaedics

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“…6 It is acknowledged that patients who present to the CED or fracture clinic following an acute ankle injury with a painful swollen ankle, an inability to weight-bear, and radiologic signs of a stable injury (avulsion fracture of the distal fibula, SH1 injury, ankle sprain) are often treated with a period of immobilization of the ankle joint with encouragement to weight-bear as able. 7,8 Immobilization of the ankle joint is most often achieved by below-knee weight-bearing synthetic casts or functional braces, which include elastic bandage and taping, ankle braces, or removable walker boots. Given the variety of functional treatment approaches available, there is a degree of subjectivity in their application.…”

mentioning

confidence: 99%

Functional Walker Boots are Preferred to Synthetic Casts by Patients and Carers in the Management of Pediatric Stable Ankle Injuries

Hampton,

Hilton,

Nicolaou

et al. 2023

Journal of Pediatric Orthopaedics

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Introduction: Traditionally children who presented with a stable ankle injury have been managed in a below-knee synthetic cast. No previous study has investigated patient and parents/carer preference between synthetic casts and walker boots. Methods: Children aged between 6 and 16 years who presented with stable ankle injuries (ankle sprains, small fragment avulsions, and fibular Salter-Harris 1 injuries) were randomized to receive treatment with either a synthetic cast or a walker boot. A tailored, study-specific questionnaire was designed and completed at 4 weeks from injury to evaluate both patient and parents/carer preference. An analysis of costs associated with both treatments was performed. Results: Ninety-one patients were available for final analysis. Forty-seven received synthetic cast treatment and 44 walker boot treatment. Patient demographics and injury types were matched between groups. Statistical significance was found in favor of the walker boot with regard to comfort, reduction in activity during treatment, and patient-reported problems at the end of treatment. There was a strong and significant preference toward treatment with the walker boot, both from patients and parents/carers. There was no difference between groups with regard to walking ability, analgesia requirement, and patient-reported pain scores. Unplanned attendances to the hospital during the treatment period were higher in the synthetic cast group. The overall treatment cost per patient was lower with the walker boot. Conclusions: In children who present with stable ankle injuries, treatment in a walker boot is preferred by both patients and parents/carers. It results in fewer unplanned attendances to the hospital, is less expensive, and we recommend it as the treatment of choice in stable pediatric ankle injuries. Level of Evidence: Level II.

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Interventions for treating ankle fractures in children

Yeung

Jia

Miller

et al. 2016

Cochrane Database of Systematic Reviews

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There is low-quality evidence of a quicker recovery of self reported function at four weeks in children with clinically diagnosed low-risk ankle fractures who are treated with an ankle brace compared with those treated with a rigid cast, especially a non-removable walking cast. There is otherwise a lack of evidence from randomised controlled trials to inform clinical practice for children with ankle fractures. Research to identify and address priority questions on the treatment of these common fractures is needed.

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Interventions for treating ankle fractures in children

Cited by 3 publications

References 20 publications

Controlled Ankle Movement (CAM) Boot Provides Improved Outcomes With Lower Complications Than Short Leg Walking Cast in Low-energy Pediatric Lateral Ankle Injuries: A Prospective, Randomized Study

Controlled Ankle Movement (CAM) Boot Provides Improved Outcomes With Lower Complications Than Short Leg Walking Cast in Low-energy Pediatric Lateral Ankle Injuries: A Prospective, Randomized Study

Functional Walker Boots are Preferred to Synthetic Casts by Patients and Carers in the Management of Pediatric Stable Ankle Injuries

Interventions for treating ankle fractures in children

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