Today's News

Saturday, March 3, 2001

Below the knee casting results in less frequent hospitalization

Historically, displaced ankle fractures have been initially treated with closed reduction and placement of an above knee cast. Presumably, say investigators in poster exhibit 477, the above knee cast is required to maintain reduction by providing rotational stability and to neutralize muscular forces. The investigators initiated a study to determine whether any difference in maintenance of reduction was observed between above knee and below knee cast treatment of displaced ankle fractures.

They found that below knee casting affords patients easier ambulation, decreased need for main-tenance due to loosening and break-age and less frequent hospitalization. "This study suggests that below knee casting may be equally as effective as above knee immobilization in maintenance of reduction of displaced ankle fractures," say investigators Suzanne L. Miller, MD, New York, N.Y.; and Steven B. Weinfeld, MD, Mount Sinai Medical Center, New York, N.Y.

Fifty-eight consecutive patients with displaced ankle fractures were prospectively randomized into two groups treated with either an above knee or below knee cast. Initial reduction was evaluated radiographically. If postreduction radiographs revealed less than 2mm displacement, closed treatment was initiated. Patients were seen for three consecutive weekly visits to evaluate maintenance of reduction. Medial clear space and talocrural angles were measured on the mortise view at each visit.

Of the 58 patients treated for displaced ankle fractures between April 1999 and March 2000, 39 were available for follow up. Statistical analysis of measurements of the medial clear space and talocrural angle showed no significant difference in maintenance of reduction with above or below knee immobilization.

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2001 Academy News March 3 Index A

Last modified 03/March/2001 by IS