People recover faster after ankle fracture surgery if they are given a removable cast or splint that lets them exercise the ankle, rather than their foot being placed in an immobilising plaster cast, a review has concluded.
Cochrane researchers have found that if the fracture is stable, then encouraging them to walk soon after surgery is also beneficial. However, increased activity does increase the chance of experiencing problems with the surgical wound.
Ankle fracture is one of the most common fractures of the lower limb, especially in young men and older women. In about half of the cases, surgery is required to realign the bones, and then the lower leg and foot are placed in a cast to immobilise and protect the area.
However, immobilisation can lead to pain, stiffness, weakness and swelling in the ankle. The researchers therefore examined whether the use of removable casts or splints could improve the outcome.
They found only limited evidence, but current research indicates that removable casts or splints, which allow the ankle to be exercised soon after surgery, reduce pain and increase mobility when compared to using a traditional plaster cast. However, early exercise on the ankle also leads to increased, albeit mainly minor, adverse events, such as problems with the surgical wound and changes in skin sensation.
"Getting a patient to exercise soon after surgery has significant benefits, but the increased risks to the wound show that you need to make sure that a person can do this safely before supplying them with a removable cast or splint, instead of a standard cast," explained Christine Lin of The George Institute for International Health in Australia.
The review is published in the latest update of The Cochrane Library.