Removable brace effective alternative to traditional plaster cast for patients with ankle fracture

A. Haque et al conducted a study to compare the longer-term outcomes of operatively and non operatively managed patients treated with a removable brace (fixed-angle removable orthosis) or a plaster cast immobilization for an acute ankle fracture. The study was conducted at ‘Warwick University, Coventry, UK’ and published in “THE BONE & JOINT JOURNAL.”

This is a secondary analysis of a multicentre randomized controlled trial comparing adults with an acute ankle fracture, initially managed either by operative or nonoperative care. Patients were randomly allocated to receive either a cast immobilization or a fixed-angle removable orthosis (removable brace). Data were collected on baseline characteristics, ankle function, quality of life, and complications. The Olerud-Molander Ankle Score (OMAS) was the primary outcome which was used to measure the participant’s ankle function. The primary endpoint was at 16 weeks, with longer-term follow-up at 24 weeks and two years.

Key findings of the study were:

• Overall, 436 patients (65%) completed the final two-year follow-up.

• 216 remained in the cast group and 220 patients in the brace group.

• The mean difference in OMAS at two years was -0.3 points favouring the plaster cast (95% confidence interval -3.9 to 3.4), indicating no statistically significant difference between the interventions.

• There was no evidence of differences in patient quality of life (measured using the EuroQol five dimension five-level questionnaire) or Disability Rating Index.

The authors concluded that – “This study demonstrated that patients treated with a removable brace had similar outcomes to those treated with a plaster cast in the first two years after injury. A removable brace is an effective alternative to traditional immobilization in a plaster cast for patients with an ankle fracture.”

Take home message stated by the authors was – “ A removable brace is as effective as traditional immobilization in a plaster cast for patients with an ankle fracture. This applies long-term to patients treated both operatively and nonoperatively.”

Further reading:

Use of cast immobilization versus removable brace in adults with an ankle fracture: two year follow-up of a multicentre randomized controlled trial, A. Haque, H. Parsons et al, THE BONE & JOINT JOURNAL, Bone Joint J 2023;105-B(4):382–388.