Comparison of below knee cast and elasticated support bandage treatment for an isolated fracture of the lateral malleolus
Abstract
Introduction: Ankle fractures are the most common type of fractures treated in orthopaedics with isolated malleolar fractures, accounting for two-thirds of fractures. The most common injury mechanism is supination external rotation, which accounts for the majority of all ankle fracture patterns. Supination external rotation stage II is the classic short oblique fracture of the distal fibula without a medial side injury, which responds well to non-operative treatment as it is a stable fracture. The purpose of this study is to compare efficacy of elasticated support bandage versus plaster cast in the patient with isolated lateral malleolus fracture (Lauge-Hansen supination- eversion external stage II.)Method: A prospective comparative study was carried out in the Department of Orthopaedics in Bir Hospital from February 2007 to January 2009. Patients with ankle fracture were initially treated by below knee posterior slab for seven days to allow the swelling to subside and on seventh day follow-up they were grouped in two groups. Group A were patients with below knee cast and Group B were elasticated support bandage. Both groups were followed-up in the 5th week for cast or elasticated bandage removal and were evaluated after a week, thereafter, every monthly for 3 months and finally at 6 month.Result: Of the 48 cases enrolled, the mean age of the patients was 38.85 years. The common mode of injury was fall from height followed by road traffic accident. The modified subjective ankle score of Olerud and Molander (1984) was found more in group B in comparison to group A in all follow ups. In initial three successive follow ups at 6 week, 12 week and at 3 month subjective score was found statistically significant (p> 0.05) however, it was not significant at 6 month follow up. The range of motion was significantly improved in group B in all follow ups but the difference between the two groups at 6 weeks and 10 weeks follow ups was statistically significant. Immobilized group required less analgesic but the difference was not significant statistically.Conclusion: Both below knee cast and elasticated support bandage treatment methods are safe, satisfactory and equally effective with a better early result in elasticated support bandage. Supination External Rotation stage II type fracture can be treated conservatively, if there is no medial tenderness.References
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14. Elliot S, Wood J. The Archeological Survey of the Nubia Report. 1910;2:1907-8.
15. Brink O, Staunstrup H, Sommer J. Stable lateral malleolar fractures treated with aircast ankle brace and DonJoy R.O.M.-Walker brace: a prospective randomized study. Foot Ankle Int 1996 Nov;17(11):679-84.
16. Cedell CA. Supination- Outward Rotation injuries of the ankle: A clinical and roentgenological study with special reference to the operative treatment. Acta Orthop Scand 1967; Suppl 110.
17. Michelson JD, Magid D, Ney DR, Fishman EK. Examination of the pathologic anatomy of ankle fractures. J Trauma 1992;32:65-70.
18. Dietrich A, Lill H, Engel T, Schönfelder M, Josten C. Conservative functional treatment of ankle fractures. Arch Orthop Trauma Surg 2002 April;122:165-8.
19. Stuart PR, Brumby C, Smith SR. Comparative study of functional bracing and plaster cast treatment of stable lateral malleolar fractures. Injury 1989 Nov;20(6):323-6.
20. Port AM, McVie JL, Naylor G, Kreibich DN. Comparision of two conservative methods of treating an isolated fracture of the lateral malleolus. J Bone Joint Surg Br 1996;78B:568-72.
2. Marse JL, Saltzman CL. Ankle Fractures. In: Rockwood CA, Green DP, Bucholz RW Heckman JD, editor. Rockwood and Green’s Fracture in Adults. 5th ed. Philadelphia (PA): Lippincott Williams & Wilkins; 2001. p.2000-9.
3. Michelson J, Solocoff D, Waldman B, Kendell K, Ahn U. Ankle Fractures: Biomechanics of Foot and Ankle. Clin Orthop 1977;122:10-7.
4. Vander GR, Michelson JD, Bone LB. Fractures of Ankle and the Distal Part of the Tibia. J Bone Joint Surg Am 1996;78:177-283.
5. Lauge-Hansen N. Fracturesof ankle. II combined experimental-surgical and experimental roentgenologic investigations. Arch Surg.1950;60:957-85.
6. Leland RH, Mast JW. Ankle fractures and dislocations including pylon fractures. In: Chapman MW, editor. Chapman’s orthopaedic surgery, 3rd ed. Philadelphia (PA): Lippincott Williams & Wilkins; 2001. p.811-45.
7. Johannes Yde. The Lauge Hansen classification of malleolar fractures. Acta orthop scand 1980;51:181-92.
8. Ryd L, Bengtsson S. Isolated fracture of the lateral malleolus requires no treatment. 49 prospective cases of supination-eversion Type II ankle fractures. Acta Orthop Scand 1992;63(4):443-6.
9. Bauer, Jonsson, Nilsson. Thirty-year Follow-up of Ankle Fractures. Acta Orthop Scand 1985;56:103-6.
10. Kristensen KD, Hansen T. Closed treatment of ankle fractures: Stage II Supination-Eversion Fractures Followed for 20 years. Acta Orthop Scand 1985;56:107-9.
11. Johannes Yde, Kristensen KD. Ankle Fractures. Supination-Eversion Fractures Stage II Primary and Late Results of Operative and Non-Operative Treatment. Acta Orthop Scand 1980;51:695-702.
12. Olerud C, Molander H. A scoring score for symptom evaluation after ankle fracture.Arch Orthop Trauma Surg. 1984;103:190-4.
13. Ryd L, Bengtsson S. Isolated fracture of the lateral malleolus requires no treatment. 49 prospective cases of supination-eversion Type II ankle fractures. Acta Orthop Scand 1992;63(4):443-6.
14. Elliot S, Wood J. The Archeological Survey of the Nubia Report. 1910;2:1907-8.
15. Brink O, Staunstrup H, Sommer J. Stable lateral malleolar fractures treated with aircast ankle brace and DonJoy R.O.M.-Walker brace: a prospective randomized study. Foot Ankle Int 1996 Nov;17(11):679-84.
16. Cedell CA. Supination- Outward Rotation injuries of the ankle: A clinical and roentgenological study with special reference to the operative treatment. Acta Orthop Scand 1967; Suppl 110.
17. Michelson JD, Magid D, Ney DR, Fishman EK. Examination of the pathologic anatomy of ankle fractures. J Trauma 1992;32:65-70.
18. Dietrich A, Lill H, Engel T, Schönfelder M, Josten C. Conservative functional treatment of ankle fractures. Arch Orthop Trauma Surg 2002 April;122:165-8.
19. Stuart PR, Brumby C, Smith SR. Comparative study of functional bracing and plaster cast treatment of stable lateral malleolar fractures. Injury 1989 Nov;20(6):323-6.
20. Port AM, McVie JL, Naylor G, Kreibich DN. Comparision of two conservative methods of treating an isolated fracture of the lateral malleolus. J Bone Joint Surg Br 1996;78B:568-72.
Published
2016-08-02
How to Cite
MAHARJAN, Rajram.
Comparison of below knee cast and elasticated support bandage treatment for an isolated fracture of the lateral malleolus.
J Soc Surg Nep, [S.l.], v. 17, n. 2, p. 12-17, aug. 2016.
ISSN 2392-4772.
Available at: <https://jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=165>. Date accessed: 01 dec. 2023.
Issue
Section
Original Article
Keywords
Below knee cast; Elasticated support bandage; Fracture; Lateral malleolus, Olerud and Molander.
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