Cast versus removable orthosis for the management of stable type b ankle fractures: A systematic review and meta-analysis

Abstract text (incl. references and figure legends)

Purpose: There is currently no consensus on nonoperative management in adult patients after a stable type B ankle fracture. The aim of this review is to compare a removable orthosis versus a cast regarding safety and functional outcome in the NOM of stable type B ankle fractures.

Results: Five studies were included. Two were randomized clinical trials, and three were observational studies, including a total of 516 patients. A meta-analysis showed statistically significant higher odds of developing complications in the cast group (odds ratio (OR), 4.67 (95% Confidence Interval (CI) 1.52 to 14.35)) (figure 1). The mean difference of functional outcome in OMAS did not vary significantly at six weeks; OR -6.64 (95% CI -13.72 to 0.45)), and 12 weeks; OR -6.91 (95% CI -18.73 to 4.91) (figure 2). The mean difference of functional outcome in OMAS at 26 weeks or longer was significantly higher in the removable orthosis group in favour of the removable orthosis; OR -2.63 (95% CI -5.01 to -0.25).

Conclusion: Results of this systematic review and meta-analysis show that a removable orthosis is a safe alternative type of NOM, as complication numbers are significantly lower in the orthosis group. In addition, no statistically significant differences were found in terms of functional outcome between a removable orthosis and a cast at six and twelve weeks. After 26 weeks a removable orthosis is non-inferior to a cast in terms of functional outcome in patients with stable type B ankle fractures.

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