brace vs. cast for Salter I & II distal fibula fractures

QUICK OVERVIEW:

--Isolated non-displaced Salter type I & II distal fibula fx’s and avulsion fx’s are very low risk for long-term complications (i.e. growth arrest – no reports found after lit review)

--For an unstable ankle, the ligaments connecting the tibia, fibula and talus must be broken in 2 places; with Salter I/II fibula fx ligament only broken in 1 place

--removable ankle brace (e.g. Air-Stirrup) vs. traditional casts: in a non-inferiority RCT single blind study, removable ankle brace patients had...

• less functional morbidity
• more rapid return to baseline activity (~80% back to baseline activity with brace in 4 wks, vs ~60% of those with cast)
• preferred by patient and families
• more cost-effective

--Can advise parents/patient to expect pain for next 2-4 weeks, full return to competitive sports usually in 6-12 weeks

Submitted by F. DiFranco. 

Reference(s): Boutis, K., et al. A randomized controlled trial of removable brace versus casting in children with low-risk ankle fractures. Pediatrics. 119(6):1256-1263, June 2007; Boutis, K., et al. Common pediatric fractures treated with minimal intervention. Pediatric Emergency Care. 26(2):152-157, Feb. 2010., picture