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About SickKids

July 5, 2007

Brace provides more efficient and effective treatment for low-risk ankle fractures

Children with low-risk ankle fractures recover faster when treated with a removable brace rather than the traditional cast. A study at The Hospital for Sick Children (SickKids), published in the June issue of the journal Pediatrics, challenging the current practice of routine casting and the necessity for orthopedic care, has found the brace provides earlier recovery of physical function. Additionally, the brace is associated with greater patient and family satisfaction and is also less costly.

Ankle injuries are very common among children. Although most are minor sprains and common fractures with little need for imaging or subspecialty care, these stable, low-risk fractures are often treated with a cast for three to four weeks, meaning the patient endures unpleasant and prolonged immobilization and the inconvenience of return visits to an orthopedic facility.

Through a randomized clinical trial comparing a below-knee fiberglass walking cast with a removable ankle brace, SickKids researchers found that children treated with the brace recovered faster although after four weeks of treatment patients experienced no differences in pain, ability to bear weight, and range of motion. By three months there were no differences in other residual symptoms such as swelling or activity levels.

More than half of the patients treated with a brace said they were “very happy” while only 18 per cent of those treated with a cast described their experience the same way. And more than half of the patients treated with a cast said they would have preferred the brace. Although patients’ parents had no treatment preference, they were significantly more satisfied when their children were treated with the brace which can be applied readily by any health care provider, and can be applied or taken off easily by older children or an adult family member.

The convenience and efficiency of the brace may also reduce costs, in part because emergency department visits can be reduced or even avoided. Instead, patients diagnosed in a primary care setting with a low-risk ankle fracture can be treated immediately. Since the brace does not require the specialty orthopedic involvement generally required for a cast, the routine referral to an orthopedic surgeon is unnecessary. Follow-up visits in busy general or paediatric orthopedic clinics are also prevented.

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The Hospital for Sick Children