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Simple fibula fractures can be treated with splinting
Question clinique
Can patients with stable fibula fracture (Weber B type) be treated with a splint rather than a cast?
L’Essentiel
Splinting or casting for 3 weeks is at least as effective as a typical casting for 6 weeks, with less risk of developing a deep vein thrombosis. 1b
Référence
Plan de l'etude: Randomized controlled trial (single-blinded)
Financement: Government
Cadre: Outpatient (specialty)
Sommaire
The authors enrolled 247 patients, 16 years or older, with radiographic evidence of an isolated Weber B type fibula fracture and congruent ankle mortise. The patients were randomized, using concealed allocation, to receive casting for 3 weeks or 6 weeks, or splinting for 3 weeks, which could be removed at will. Outcome assessors were unaware of treatment assignment. Using intention-to-treat analysis, ankle symptoms (using the Olerud-Molander Ankle Score) at 12 months were similar between the 3 groups. There were 2 instances of nonunion in the 3-week cast group, but none in the splint group or in the 6-week cast group. Deep vein thrombosis occurred in the patients with casts, but not in patients with splints.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Commentaires
Stable Weber B fractures
The synopsis does not report that the fractures had to be stable in order to be entered into this trial. Stability was determined by an external rotation stress test done under fluoroscopy. This is an important point not to be missed and could lead to inappropriate treatment if not done.