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At least 55 records · Page 3Linked to original sources
PubMed2006

Effect of neuromuscular electrical stimulation on ankle swelling in the early period after ankle sprain.

BACKGROUND AND PURPOSE: Neuromuscular electrical stimulation (NMES) is frequently used to decrease swelling in the early period after ankle sprain. The purpose of this study was to evaluate its effectiveness in this treatment. SUBJECTS: Thirty-four subjects (11 female, 23 male; mean age=30.2 years) who were recovering from ankle sprain participated. METHODS: Outcome measures were ankle-foot volume, ankle girth, and self-assessed ankle function. Three testing raining sessions occurred within 5 days of injury. Subjects were randomly assigned to 1 of 3 groups: a group that received NMES treatment, a group that received submotor ES treatment (designed to act as a control group), and a group that received sham treatment. RESULTS: There were no statistically significant differences among the groups for ankle-foot volume and self-assessed ankle function. The statistically significant differences for ankle girth may have been compromised due to the significantly different values among groups at baseline. Ankle girth measurements were shown to be statistically significant from session 1 to session 3 for the NMES group but not for the other 2 groups. DISCUSSION AND CONCLUSION: The results indicate that NMES, as designed and used in this study, is not effective in decreasing ankle-foot volume or increasing self-assessed ankle function in the early period after ankle sprain.

Adult↗
PubMed2006

Initial changes in posterior talar glide and dorsiflexion of the ankle after mobilization with movement in individuals with recurrent ankle sprain.

STUDY DESIGN: A double-blind randomized crossover experimental study with repeated measures, including a no-treatment control condition. OBJECTIVE: To evaluate the initial effect of 2 mobilization with movement (MWM) treatment techniques performed in weight bearing and non-weight bearing on posterior talar glide and talocrural dorsiflexion in individuals with recurrent lateral ankle sprain. BACKGROUND: MWM treatment techniques are commonly used in the treatment of musculoskeletal pain, such as lateral ankle sprain. Recent evidence indicates that a lack of posterior talar glide and weight-bearing ankle dorsiflexion are common physical impairments in individuals with recurrent ankle sprains. MWM of the ankle joint involves the application of a combined posterior talar glide mobilization and active dorsiflexion movement. The recurrent ankle sprain injury and the MWM treatment techniques for the ankle seemingly provide an appropriate model to further evaluate the effects and mechanism(s) of action of the MWM treatment techniques in a way that they have not been tested to date. METHODS: Sixteen subjects (mean +/- SD age, 19.8 +/- 2.3 years) with a history of recurrent lateral ankle sprain and deficits in posterior talar glide (71%) and weight-bearing dorsiflexion (34%) were studied. A within-subjects study design was used to evaluate the effect of 2 independent variables: treatment conditions (weight-bearing MWM, non-weight-bearing MWM, and a no-treatment control group) and time (pretreatment and posttreatment) on the dependent variables of posterior talar glide and weight-bearing dorsiflexion. RESULTS: Both the weight-bearing and non-weight-bearing MWM treatment techniques significantly improved posterior talar glide by 55% and 50% of the preapplication deficit between affected and unaffected sides, respectively, which was significantly greater than that of the control group (P<.001). The weight-bearing and non-weight-bearing MWM treatment techniques improved weight-bearing dorsiflexion by 26% (P<.017), compared to 9% for the control condition. The change in posterior talar glide, expressed as a proportion of pretreatment deficit, was correlated to the change in weight-bearing dorsiflexion (r = .88, P<.001), but only after the weight-bearing MWM technique. CONCLUSION: This preliminary study demonstrated an initial ameliorative effect of MWM treatment techniques on posterior talar glide and dorsiflexion range of motion in individuals with recurrent lateral ankle sprain. These results suggest that this technique should be considered in rehabilitation programs following lateral ankle sprain. This study provides justification for follow-up research of the long-term effects of MWM on lateral ankle sprain and proposes further work be conducted on the posterior talar glide test.

Adult↗
PubMed2005

Ankle function during gait in patients with chronic ankle instability compared to controls.

BACKGROUND: Despite much research, the reasons behind the development of chronic ankle instability in individuals post ankle inversion sprain are unknown. Chronic ankle instability has not previously been investigated dynamically using 3D motion analysis during walking. We hypothesised that chronic ankle instability subjects would exhibit a different kinematic and kinetic pattern during normal walking when compared with a control group. METHODS: Gait analysis was carried out on fifty subjects (25 chronic ankle instability, and 25 age, gender, activity, and gait velocity matched controls) during walking. Kinematic and kinetic pattern differences using the 3D motion analysis system combined with a force plate were established during 100 ms pre-heel strike and 200 ms post-heel strike, between the chronic ankle instability subjects and controls during normal walking. FINDINGS: Chronic ankle instability subjects were significantly (P<0.01) more inverted in the frontal plane compared to controls from 100 ms pre-heel strike to 200 ms post-heel strike. The joint angular velocity was significantly (P<0.05) higher at heel strike in the chronic ankle instability group. During the early stance phase of gait chronic ankle instability subjects appear to be controlled by an evertor muscle moment working concentrically compared to an invertor muscle moment working eccentrically in the controls. INTERPRETATION: These changes in kinematics and kinetics which arise are likely to result in increased stress being applied to ankle joint structures during the heel strike and loading response phases of the gait cycle. This could result in repeated injury and consequent damage to ankle joint structures.

Adult↗
PubMedDate not supplied

The effect of external ankle support in chronic lateral ankle joint instability. An electromyographic study.

We examined the effect of ankle taping on ankle joint stability by measuring mechanical stability using standardized stress radiographs. Anterior talar translation and talar tilt, both with and without ankle tape, were examined. The reduction of anterior talar translation and talar tilt with tape as compared to without tape was insignificant. The reaction time of the peroneus muscles was measured by electromyographic signal after a simulated ankle sprain on a tilting trapdoor. The reaction time was significantly slower in the unstable ankles of 20 athletes with unilateral ankle instability than in the stable contralateral ankles. With tape, the reaction time was significantly shortened, although not back to normal. The greatest improvement in reaction time was achieved in ankles with the highest degree of mechanical instability. Thus, the mechanism behind the function of ankle tape may be to restrict the extremes of ankle motion and to help shorten the reaction time of the peroneus muscles by affecting the proprioceptive function of the ankle.

Adult↗
PubMed2002

Comprehensive testing of 10 different ankle braces. Evaluation of passive and rapidly induced stability in subjects with chronic ankle instability.

OBJECTIVE: The aim of the present investigation was to test the stability of 10 different ankle braces under passive and rapidly induced loading conditions in a population suffering from chronic ankle instability in order to provide objective information to choose or recommend an appropriate model for specific needs. In addition, the relationship between passive and rapidly induced testing of the stabilizing effect against inversion was evaluated to identify if passive support characteristics of braces are reflected under rapidly induced conditions. DESIGN: An experimental in vivo study with a repeated-measures design was used. BACKGROUND: Ankle braces are commonly used for treatment, rehabilitation, and prevention of ankle injuries. A variety of products exists but there is few information available to assist clinicians, physiotherapists and coaches as well as consumers in choosing a brace on a basis of objective information. Furthermore, there is a lack of studies that provide data for both passively and rapidly induced movement of the ankle joint when using different ankle braces. METHODS: Twenty-four subjects with chronic ankle instability participated in the project. Passive ankle range of motion measurements were performed in a custom-built fixture and simulated inversion sprains were elicited on a tilting platform. RESULTS: The tested braces restrict range of motion significantly compared to the no-brace condition for both the passively and rapidly induced inversion and marked differences between braces were revealed. A close relationship between passive and rapidly induced test results for inversion was found. CONCLUSIONS: Passive as well as rapidly induced stability tests provide a basis of objective information to describe the characteristics of different ankle braces. Combined results of passive and rapidly induced inversion as well as correlation between results demonstrate that passive support characteristics of braces are reflected under rapidly induced conditions but the amount of restriction is reduced. Therefore, caution should be taken when recommending braces for applications under dynamic circumstances only on the basis of passive support characteristics. RELEVANCE: A basis of information regarding the stability characteristics of different ankle braces under passive and rapidly induced conditions will help the clinician and consumer in choosing the most appropriate brace model for specific use. The results also provide more insights into factors that influence stability characteristics of ankle braces.

Adult↗
PubMed2004

Takedown of ankle fusion and conversion to total ankle replacement.

The painful ankle arthrodesis is an unsolved clinical problem. In many cases, transtibial amputation may be the best option for functional recovery. Recent reports of early success with second generation ankle implants show takedown of the problematic ankle fusion and conversion to total ankle arthroplasty may be an alternative to amputation. This study is a retrospective review of 23 ankles in 22 patients scheduled to have this procedure. Four patients were lost to followup, leaving 19 ankles in 18 patients at an average followup of 39 months. Three patients chose to have an amputation because of continued pain. In the remaining 16 ankles, the mean AOFAS ankle-hind foot outcome score improved from 42-68. Patients who had a clear source of pain with the ankle arthrodesis (such as subtalar arthrosis) had a better result than patients without a clear source of pain. All the patients who had the lateral malleolus resected during previous arthrodesis had complicated courses after arthroplasty. For patients with a definable source of pain and who have not had previous malleolar resection, conversion of a failed ankle arthrodesis to total ankle arthroplasty may be a viable alternative to amputation.

Adult↗
PubMedDate not supplied

The efficacy of a semirigid ankle stabilizer to reduce acute ankle injuries in basketball. A randomized clinical study at West Point.

This randomized clinical study was designed to prospectively determine the efficacy of a semirigid ankle stabilizer in reducing the frequency and severity of acute ankle injuries in basketball. Athletic shoe, playing surface, athlete-exposure, ankle injury history, and brace assignment were either statistically or experimentally controlled. Participants in the study were 1601 United States Military Academy cadets with no preparticipation, clinical, functional, or radiographic evidence of ankle instability. Subjects experienced a total of 13,430 athlete-exposures in the 1990 and 1991 intramural basketball seasons. Ankle injury was defined as acute trauma to the ankle ligaments that resulted in an athlete's inability to participate in basketball 1 day after the injury. Use of ankle stabilizers significantly reduced the frequency of ankle injuries. Reduction in ankle injuries, however, depended on the nature of injury (fewer contact injuries occurred among those who wore braces). Injury severity was not statistically reduced, and wearing the ankle stabilizer did not affect the frequency of knee injuries. Attitude toward ankle stabilizer use improved as use of the stabilizer increased.

Adult↗
PubMed1997

Effect of ankle orthoses on functional performance for individuals with recurrent lateral ankle sprains.

Ankle orthoses are commonly used for protection against initial ankle sprain injuries and for protection against reinjury. The purpose of this study was to compare the effects of the DonJoy Ankle Ligament Protector (ALP) and the Aircast Sport-Stirrup (AS) on the functional performance tasks of a 40-meter sprint, a figure-of-eight run, and standing vertical jump. Subjects were 14 males and nine females who reported a history of two or more lateral ankle sprains of the same ankle and no sprains of the contralateral ankle. Each subject performed all functional tasks on the first test day with both ankles unbraced and with the recurrently sprained ankle braced with one of the two orthoses. Each subject returned for testing on a second day and performed all tasks with both ankles unbraced and with the other orthosis on the recurrently sprained ankle. Subjects also rated the orthoses for comfort and support. Analysis of variance indicated that braced data were not significantly different than unbraced data and that data for the two orthoses did not differ significantly for any of the functional performance tasks. Seventy-four percent of the subjects reported the AS was more comfortable than the ALP, and 61% of the subjects indicated that the AS provided more support than the ALP. Neither orthosis had an effect on functional performance. The results may assist clinicians in selecting either of these orthoses for use in protection against ankle sprain injury.

Adolescent↗
PubMed2000

Ultrasound therapy for acute ankle sprains.

BACKGROUND: Ultrasound is used in the treatment of a wide variety of musculoskeletal disorders. OBJECTIVES: To evaluate the effects of ultrasound therapy in the treatment of acute ankle sprains. SEARCH STRATEGY: MEDLINE and EMBASE up to December 1998 and databases of the Cochrane Rehabilitation and Related Therapies Field and Musculoskeletal Injuries Group were searched. This was supplemented with citation tracking, and contact with colleagues. Date of the most recent search: April 1999. SELECTION CRITERIA: Randomised or pseudo-randomised trials were included in the review if the following conditions were met: at least one study group was treated with active ultrasound; the study included patients with acute lateral ankle sprains; and outcome measures included general improvement, pain, swelling, functional disability, or range of motion. Final selection of papers was conducted by two independent reviewers. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality using a standardised checklist, and extracted data. Whenever possible, the results were analysed on an intention-to-treat basis. Fixed odds ratios together with 95% confidence intervals were calculated for dichotomous outcomes, and weighted or, where different scales were used, standardised mean differences together with 95% confidence intervals for continuous outcome measures. Pooling of data was undertaken where there was clinical homogeneity in terms of subjects, treatments, outcomes, and follow-up time points. MAIN RESULTS: The four included trials, involving 514 patients, were only of modest methodological quality. None of the three placebo-controlled trials (sham ultrasound) could demonstrate statistically significant differences between true and sham ultrasound therapy for any outcome measure at seven days of follow-up. The pooled odds ratio for general improvement was 1.19 (Peto fixed effects model, 95% confidence interval 0.73 to 1.93) for the comparison between ultrasound and sham ultrasound. The differences between intervention groups were generally small, between 0 and 6% for most dichotomous outcomes. However, one trial reported relatively large differences for pain free status (20%) and swelling (25%) in favour of ultrasound treatment. REVIEWER'S CONCLUSIONS: The extent and quality of the available evidence for the effects of ultrasound therapy for acute ankle sprains are limited. The results of three placebo-controlled trials do not support the use of ultrasound in the treatment of ankle sprains. The magnitude of most reported treatment effects appeared to be small, and may be of limited clinical importance. As yet, only few trials are available and no conclusions can be made regarding an optimal and adequate dosage schedule for ultrasound therapy, and whether such a schedule would improve on the reported effectiveness of ultrasound for ankle sprains.

Ankle Injuries↗
PubMed2006

Risk-factor analysis of high school basketball-player ankle injuries: a prospective controlled cohort study evaluating postural sway, ankle strength, and flexibility.

OBJECTIVE: To analyze risk factors, including postural sway, ankle strength, and flexibility, for the prediction of ankle injuries in men's high school basketball players. DESIGN: A cohort study with follow-up duration of 1 basketball season. SETTING: Biomechanics laboratory. PARTICIPANTS: Forty-two (age, 16.5+/-1.1y) players competing in first league of the High School Basketball Association without history of injury in the lower extremities within 6 months before recruitment and without significant malalignment in the lower extremities were included. None of these players met exclusion criteria such as using ankle braces or taping or failed in wearing low-top sports shoes during the follow-up season. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Biomechanic measurements including isokinetic ankle strength, 1-leg standing postural sway, and ankle joint dorsiflexion flexibility were performed before the basketball season by 1 physical therapist. The subsequent monthly follow-up questionnaires were sent and returned by mail to prospectively record the incidence of ankle injury occurring in the season. Results of these preseason measurements were analyzed to correlate if any of these measured variables could predict future ankle injuries. RESULTS: Eighteen ankle sport injuries were recorded for 42 players during the follow-up season. High variation of postural sway in both anteroposterior and mediolateral directions corresponded to occurrences of ankle injuries (P=.01, odds ratio [OR]=1.220; P< .001, OR=1.216, respectively). All other variables were not associated with injury. CONCLUSIONS: High variations of postural sway in 1-leg standing test could explain partly the increased prevalence of ankle injury in basketball players. It may be used as a screening tool to recommend balance training before basketball season.

Adolescent↗
PubMedDate not supplied

Static and dynamic roentgenographic analysis of ankle stability in braced and nonbraced stable and functionally unstable ankles.

Patients suffering from functional ankle instability were selected based on a structured interview. Talar tilt was measured using supine ankle stress roentgenographs and standing talar tilt was measured using erect ankle stress roentgenographs. A digital roentgenocinematographic analysis of a 50 degrees ankle sprain simulation was performed to measure dynamic talar tilt and inversion distance between two video images (inversion speed). A significant decrease in pathologic supine talar tilt in unstable ankles was found in the braced compared with the nonbraced situation (talar tilt = 13.1 degrees versus 4.8 degrees with brace). The talar tilt with the brace after activity was still significantly lower than the initial value without the brace. The standing talar tilt of unstable ankles was shown to be significantly lower with the orthosis than without (standing talar tilt = 16.6 degrees versus 12.0 degrees with brace). Roentgenocinematographic evaluation of ankle sprain simulation showed that the mean dynamic talar tilt during simulated sprain decreased significantly in the braced ankles compared with the nonbraced ankles (dynamic talar tilt = 9.8 degrees versus 6.4 degrees braced). A significant decrease in the digital measurement of inversion distance (from 110.6 pixels to 92.4 pixels) was observed in the total sample of 39 ankles during the initial high-speed phase of the simulated sprain. The brace significantly slows down the inversion speed.

Analysis of Variance↗
PubMed2006

Gait analysis and functional outcomes following ankle arthrodesis for isolated ankle arthritis.

BACKGROUND: The functional outcomes following ankle arthrodesis are not known. The purpose of the present study was to compare the intermediate-term clinical results for a group of patients in whom an ankle arthrodesis had been performed with use of modern surgical techniques with the findings for a group of healthy gender and age-matched controls on the basis of validated outcome measures and gait analysis. METHODS: Twenty-six patients who had undergone ankle arthrodesis for the treatment of isolated unilateral ankle arthritis were identified and retrospectively assessed clinically and radiographically. The mean age at the time of surgery was fifty-four years, and the mean interval between surgery and assessment was forty-four months. A gender and age-matched control group of twenty-seven individuals was recruited for comparison. All subjects were evaluated with gait analysis, the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale, the Musculoskeletal Outcomes Data Evaluation and Management Systems (MODEMS) questionnaire, and the Ankle Osteoarthritis Scale (AOS). RESULTS: On preliminary review, twenty of the twenty-six patients were completely satisfied or satisfied with their surgical outcome. All patients but one stated that they would undergo the surgery again. Five patients stated that they did not notice a gait abnormality. Twelve patients wore orthotics, and all believed that the use of the orthotics improved their gait. When the functional outcome scores in the arthrodesis group were compared with those in the control group, specific scores assessing hindfoot pain and satisfaction were similar. However, scores focusing on ankle-hindfoot function and disability revealed significant differences. Gait analysis also identified significant differences between the two groups with regard to cadence and stride length. In addition, there was significantly decreased sagittal, coronal, and transverse range of motion of the hindfoot and midfoot during the stance and swing phases of gait in the arthrodesis group. Radiographic review demonstrated that four of the twenty-six patients had development of moderate to severe arthritis of the subtalar joint. CONCLUSIONS: In the intermediate term following an arthrodesis for the treatment of end-stage ankle arthritis, pain is reliably relieved and there is good patient satisfaction. However, there are substantial differences between patients and the normal population with regard to hindfoot function and gait. On the basis of these results, patients should be counseled that an ankle fusion will help to relieve pain and to improve overall function; however, it is a salvage procedure that will cause persistent alterations in gait with a potential for deterioration due to the development of ipsilateral hindfoot arthritis.

Adolescent↗
PubMed2004

Total ankle arthroplasty: a review of 11 current ankle implants.

Introduced in the early 1970s, total ankle arthroplasty offered patients with debilitating ankle arthritis reduction in pain and almost normal mobility at the ankle joint. The idea of replacing an arthritic ankle joint with a mobile ankle prosthesis was originally welcomed to replace ankle arthrodesis. Unfortunately, high failure rates of first-generation implants led many surgeons in the United States to recommend ankle arthrodesis as the best alternative. An improved understanding of ankle joint mechanics, implant material and design, and surgical technique has led to the development of several second-generation implants that are being used successfully throughout the world. As short-term, mid-term, and long-term results continue to be published, there has been a momentous change in the outlook of total ankle arthroplasty as a viable option to ankle arthrodesis.

Ankle Joint↗
PubMed2001

The efficacy of adjusting the ankle in the treatment of subacute and chronic grade I and grade II ankle inversion sprains.

OBJECTIVE: The purpose of this study was to determine the efficacy of adjusting the ankle in the treatment of subacute and chronic grade I and grade II ankle inversion sprains. DESIGN: A single-blind, comparative, controlled pilot study. SETTING: Technikon Natal Chiropractic Day Clinic. PARTICIPANTS: Thirty patients with subacute and chronic grade I and grade II ankle inversion sprains. Patients were recruited from the public; they responded to advertisements placed in newspapers and on notice boards around the campus and local sports clubs. INTERVENTION: Each of the 15 patients in the treatment group received the ankle mortise separation adjustment. Each of the 15 patients in the placebo group received 5 minutes of detuned ultrasound treatment. Each participant received a maximum of 8 treatment sessions spread over a period of 4 weeks. MAIN OUTCOME MEASURE: Patients were evaluated at the first treatment, at the final treatment, and at a 1-month follow-up consultation. Subjective scores were obtained by means of the short-form McGill Pain Questionnaire and the Numerical Pain Rating Scale 101. Objective measurements were obtained from goniometer readings measuring ankle dorsiflexion range of motion and algometer readings measuring pain threshold over the ankle lateral ligaments. A functional evaluation of ankle function was also used. RESULTS: Although both groups showed improvement, statistically significant differences in favor of the adjustment group were noted with respect to reduction in pain, increased ankle range of motion, and ankle function. CONCLUSIONS: This study appears to indicate that the mortise separation adjustment may be superior to detuned ultrasound therapy in the management of subacute and chronic grade I and grade II inversion ankle sprains.

Adolescent↗
PubMed1999

Prophylactic ankle stabilizers affect ankle joint kinematics during drop landings.

PURPOSE: Ankle joint dorsiflexion contributes to energy absorption during landing, but wearing ankle stabilizers is known to restrict passive measures of dorsiflexion. This study compared the effects of various ankle stabilizers on ankle joint kinematics during soft and stiff landings. METHODS: Subjects (N = 14) performed two-legged landings off a 0.59-m platform. Kinematics of the right ankle were calculated from a sagittal plane video recording (120 Hz). Five soft and five stiff landings were performed in five ankle stabilizer conditions (no stabilizer, taping, Swede-O, AirCast, and Active Ankle), a total of 50 trials per subject. Style and stabilizer conditions were randomized across subjects. Each subject's five-trial mean value of selected kinematic variables for each landing style/stabilizer condition was entered into a two-way repeated MANOVA (alpha = 0.05). RESULTS: Differences between soft and stiff landing conditions were similar to those reported in the literature. Compared with the No stabilizer condition, most stabilizer conditions significantly reduced ankle dorsiflexion ROM and angular velocity during landing. CONCLUSIONS: The results indicate that some ankle stabilizers adversely affect ankle joint kinematics during landing.

Adult↗
PubMed2003

Population based epidemiology of ankle sprains attending accident and emergency units in the West Midlands of England, and a survey of UK practice for severe ankle sprains.

OBJECTIVES: To estimate the incidence of ankle sprains and severe ankle sprains attending accident and emergency (A&E) units; to describe current practice for severe ankle sprains in A&E units in the United Kingdom. METHODS: Crude age and sex specific incidence rates were calculated for four health districts from cases ascertained from data on seven A&E clinical information systems. Case records of patients with ankle sprains at an A&E unit in another health district were audited and the proportion of severe ankle sprains calculated. UK A&E units were surveyed about their usual treatment of patients with severe ankle sprains. RESULTS: The estimate of the crude incidence rate of ankle sprains was a minimum of 52.7 per 10 000, rising to 60.9 (95% CI 59.4 to 62.4) when figures were adjusted for the proportion of patients without a diagnostic code (13.7%). There were important age-sex differences with unadjusted rates observed from 127.8 per 10 000 (CI 115.5 to 140.0) in girls aged 10-14 years to 8.2 (CI 4.2 to 12.3) in men aged 70-74 years. As 14% of ankle sprains attending A&E were classed as severe, this would equate to 42 000 severe ankle sprains per year in the UK. In the UK wide survey, there was a response rate of 79% (211 of 266). Among the responders, Tubigrip was used routinely in 55%, below knee casts in 3%, and braces in 2%. Boots were not used routinely in any unit. CONCLUSION: While there is considerable variation in severe ankle sprain management in UK A&E units, most are treated with the minimal mechanical support of Tubigrip.

Adolescent↗
PubMed2003

Use of a cast compared with a functional ankle brace after operative treatment of an ankle fracture. A prospective, randomized study.

BACKGROUND: Controversy continues with regard to the optimal postoperative care after open reduction and internal fixation of an ankle fracture. The hypothesis of this study was that postoperative treatment of an ankle fracture with a brace that allows active and passive range-of-motion exercises would improve the functional recovery of patients compared with that after conventional treatment with a cast. Thus, the purpose of this prospective, randomized study was to compare the long-term subjective, objective, and functional outcome after conventional treatment with a cast and that after use of functional bracing in the first six weeks following internal fixation of an ankle fracture. METHODS: One hundred patients with an unstable and/or displaced Weber type-A or B ankle fracture were treated operatively and then were randomly allocated to two groups: immobilization in a below-the-knee cast (fifty patients) or early mobilization in a functional ankle brace (fifty patients) for the first six postoperative weeks. The follow-up examinations, which consisted of subjective and objective (clinical, radiographic, and functional) evaluations, were performed at two, six, twelve, and fifty-two weeks and at two years postoperatively. RESULTS: There were no perioperative complications in either study group, but eight patients who were managed with a cast and thirty-three patients who were managed with a brace had postoperative complications, which were mainly related to wound-healing. Two patients in the group treated with a cast had deep-vein thrombosis. All fractures healed well in both groups. The difference between the two groups with respect to the complication rate was significant (p = 0.0005). No significant differences between the study groups were observed in the final subjective or objective (clinical) evaluation. At the two-year follow-up examination, the average score (and standard deviation) according to the ankle-rating scale of Kaikkonen et al. was 85 +/- 9 points for the group treated with a cast and 83 +/- 10 points for the group treated with a brace, and the average ankle score according to the system of Olerud and Molander was 87 +/- 8 points and 87 +/- 9 points, respectively. CONCLUSIONS: The long-term functional outcome after postoperative treatment of an ankle fracture with a cast and that after use of a functional brace are similar. Although early mobilization with use of a functional ankle brace may have some theoretical beneficial effects, the risk of postoperative wound complications associated with this treatment approach is considerably increased compared with that after conventional cast treatment. Thus, the postoperative protocol of treatment with a functional brace requires refinement before it can be generally advocated for use after operative treatment of an ankle fracture.

Adult↗
PubMed1997

Clinical application of the Ottawa ankle rules for the use of radiography in acute ankle injuries: an independent site assessment.

OBJECTIVE: Previous studies show that the clinical criteria known as the Ottawa ankle rules (OAR), used for determining the need for radiographs of the ankle when a fracture is suspected, have a sensitivity of 100%, a specificity of 50%, and an overall reduction in radiographs of the ankle of 28%. The purpose of this study was to further assess the clinical usefulness of the OAR when implemented in an emergency department of a level 1 trauma center. SUBJECTS AND METHODS: Over a 1-year period, all patients who were between 18 and 55 years old and who presented to the emergency department with blunt ankle trauma were examined by emergency department clinicians who used the OAR to determine the need for ordering ankle radiographs. RESULTS: Of 926 patients with blunt ankle trauma, 759 met OAR criteria for ordering radiographs of the ankle. Of these patients, 152 were found to have a fracture. Another 167 of the patients were determined not to need ankle radiographs. Through either telephone contact or medical records review. 152 (91%) of these 167 patients were successfully followed up for the purpose of detecting any missed fractures. Two missed fractures were discovered, but only one required plaster immobilization. Based on these numbers, overall sensitivity using the OAR was 99% (confidence interval, 95-100%), and specificity was 22%. We found an overall 16% reduction in the number of ankle films ordered. CONCLUSION: When implemented at a level 1 trauma center, the OAR can adequately screen for ankle fractures.

Acute Disease↗