People recover faster after surgery for ankle fracture if they are given a cast or splint that can be removed to let them exercise the ankle, than if their foot is placed in an immobilising plaster cast. 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. These conclusions are published in a systematic review included in the latest update of The Cochrane Library.
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, the broken bone requires surgery to realign the bones, and then the lower leg and foot are placed in a cast to immobilise and protect the area.
The problem with immobilisation is that it can lead to pain, stiffness, weakness and swelling in the ankle. A team of Cochrane Researchers therefore looked to see whether there was evidence that using removable casts or splints can improve outcome.
The researchers found only limited evidence, but current research indicated that removable casts or splints which allow the ankle to be exercised soon after surgery reduced pain and increased mobility when compared to using a traditional plaster cast. But early exercise on the ankle also led 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," says Christine Lin, who works at the Musculoskeletal Division of The George Institute for International Health, Australia.