ArticlesMechanical supports for acute, severe ankle sprain: a pragmatic, multicentre, randomised controlled trial
Section snippets
Background
Acute ankle sprain accounts for between 3% and 5% of all UK emergency department attendances: around 1–1·5 million a year.1, 2 Most sprains are of the lateral ligament complex.2 The severity of injury is graded from I to III.3 Grade I injuries are self-limiting, with only stretching of the ligament. Grade II and III injuries are either a tear or complete rupture of the ligament complex, and are typified by inability to bear weight on the leg, and by substantial amounts of swelling.3 Incapacity,
Participants and setting
We did a multicentre randomised trial, with blinded assessment of outcome, and a 9-month follow-up period. This was a pragmatic trial, testing the provision of mechanical supports within the constraints of normal UK National Health Service (NHS) practice.
Participants with severe ankle sprain were recruited between April, 2003, and July, 2005, from eight emergency departments across England. Patients had to be over 16 years of age (to ensure skeletal maturity, and avoid inclusion of epiphyseal
Results
The study design is shown in figure 1. 680 people were potentially eligible—ie, had severe sprains. 79 people declined to participate. The most frequent reason for refusal to participate was unwillingness to accept a below-knee cast (46), Bledsoe boot (9), tubular compression bandage (4), or Aircast brace (2), or unwillingness to participate in the research after a full explanation had been given. 584 participants were randomised. Postal questionnaires were received from 83% of randomised
Discussion
Contrary to popular clinical opinion,5 a period of immobilisation was the most effective strategy for promoting rapid recovery. This was achieved best by the application of a below-knee cast. The Aircast brace was a suitable alternative to below-knee casts. Results for the Bledsoe boot were disappointing, especially in view of the substantial additional cost of this device. Tubular compression bandage, which is currently the most commonly used of all the supports investigated,6 was,
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