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European Journal of Trauma and Emergency Surgery

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Open Access 16-11-2022 | Ankle Fracture | Original Article

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

Authors: Jelle Friso Spierings, Thomas Marcus Paulus Nijdam, Lizz van der Heijden, Henk Jan Schuijt, Marike Cornelia Kokke, Detlef van der Velde, Diederik Pieter Johan Smeeing

Published in: European Journal of Trauma and Emergency Surgery | Issue 5/2023

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.

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Title: Cast versus removable orthosis for the management of stable type B ankle fractures: a systematic review and meta-analysis
Authors: Jelle Friso Spierings
Thomas Marcus Paulus Nijdam
Lizz van der Heijden
Henk Jan Schuijt
Marike Cornelia Kokke
Detlef van der Velde
Diederik Pieter Johan Smeeing
Publication date: 16-11-2022
Publisher: Springer Berlin Heidelberg
Keywords: Ankle Fracture
Orthosis
Published in: European Journal of Trauma and Emergency Surgery / Issue 5/2023
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-022-02169-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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