Plaster Casts May Be a Thing of the Past

Researchers from The George Institute for International Health (Sydney, Australia) searched two specialized registers of The Cochrane Collaboration, electronic databases (including Medline, EMBASE, and CINAHL), reference lists of included studies, relevant systematic reviews, and clinical trials registers up to September 2007. Thirty-one randomized and quasi-randomized controlled trials with adults undergoing any interventions for rehabilitation after ankle fracture were considered. The primary outcome was activity limitation; secondary outcomes included impairments and adverse events.

The researchers found that after surgical fixation, commencing exercise in a removable brace or splint significantly improved activity limitation, pain, and ankle range of motion, but also led to a higher rate of adverse events. Weight-bearing during the immobilization period improved ankle range of motion after surgical fixation; and where it was possible to avoid surgical fixation, the use of no immobilization compared to cast immobilization also improved ankle range of motion. After the immobilization period, manual therapy was beneficial in increasing ankle range of motion. There was no evidence of effect for electrotherapy, hypnosis, or stretching. The review was published in the July 2008, issue of the Cochrane Database of Systematic Reviews.

"Because of the potential increased risk, the patient's ability to comply with the use of a removable type of immobilization and exercise is essential,” concluded lead author graduate student Christine Lin Chung-Wei, P.T., of the center for evidence-based physiotherapy, and colleagues. "Our review shows that using a removable splint and doing exercises could give up to 20% additional benefit in improving a patient's mobility in the long term after an ankle fracture, compared to a fixed cast with no exercise.”

Ankle fracture is one of the most common fractures of the lower limb, especially in older women and young men. It is generally treated by surgical or nonsurgical orthopedic management, followed by a period of immobilization to protect the fracture. For people who require ankle surgery, using a removable brace or splint after the surgery so that gentle ankle exercises can be performed may enhance the return to normal activities, reduce pain and improve ankle movement. However, removable splints are at present available only for a minority of patients worldwide, and plaster casts have the advantage of keeping the healing bones in compound or open fractures immobile.


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