After an ankle fracture, a cast is often worn for a long time, with all the limitations that come with it. But the duration of immobilization has never been determined on a scientific basis. A recent study shows that the traditional six weeks of immobilization with a cast offers no faster healing than three weeks, while halving the time reduces health risks and improves quality of life.
Tero Kortekangas, an orthopedic surgeon at the Finnish Hospital of the University of Oulu, started from the consideration that remaining in a cast has health consequences: the longer a limb remains immobilized, the greater the likelihood of skin damage, deep vein thrombosis, and stiffness after the cast is removed. It thus enrolled 247 patients, with an average age of 45 years, who had incurred the most common type of ankle fracture between 2012 and 2016 but had not been referred for surgery. Divided into three groups, one third of them were made to wear a cast for the traditional six weeks, one third had the cast removed after three weeks, and the others were fitted with a simple ankle brace.
The degree of recovery was evaluated at three successive points in time: after six weeks, three months, and one year, based on the Oma (Olerud-Molander ankle) index, which is considered the most accurate system for measuring ankle health and is based on a scale of one to one hundred, where the highest scores correspond to the best condition.
After one year, as can be read in the British Medical Journal, those who had worn the cast for six weeks had the least favorable results, with an average score of 87.6 compared with 91.7 recorded in the group in which the cast was maintained for only three weeks. Also at the last follow-up, patients in all three groups showed a similar situation with regard to both the absence of pain and quality of life, but those who had worn an ankle bracelet were able to perform a slightly larger ankle movement.
It is true that ankle fractures are not particularly common, but the implications could be much broader. In fact, as Kortekangas pointed out, the result could also apply to fractures occurring in other bone segments, and so the study opens the way for a whole series of new insights.
