SLR - December 2017 - Riley L. Pett

Compression Stockings in the Management of Fractures of the Ankle: A Randomized Controlled Trial

Reference: Sultan, M. J., Zhing, T., Morris, J., Kurdy, N., & Mccollum, C. N. (2014). Compression Stockings in the Management of Fractures of the Ankle: A Randomized Controlled Trial. The Bone & Joint Journal, 96-B(8), 1062-1069. doi:10.1302/0301-620x.96b8.32941

Scientific Literature Review

Reviewed By: Riley L. Pett, DPM
Residency Program: UPMC Pinnacle Hospital, Harrisburg, PA

Podiatric Relevance: Ankle fractures are frequently associated with a long-term sequela that includes persistent pain and joint stiffness at the two- and five-year follow-up in >70 percent of patients. Deep vein thrombosis is also an inherent risk from prolonged immobilization that presents further complications in care. Even though edema is well known to decrease healing and compression stockings have shown to decrease the risk of DVT, compression stockings are not routinely used in treatment of foot and ankle surgery. In this study, the authors compared both operative and nonoperative ankle injuries with treatment of Ankle Injury Stockings (AIS) plus Aircast boot versus tubigrip plus Aircast boot.  

Methods: This was a single-center prospective, stratified, single-blind randomized controlled study comparing the treatment of ankle fractures in 90 patients with either AIS and Aircast boot versus Tubigrip and Aircast boot. Within 72 hours, Ankle injury stockings (AIS) pressure profiles were fitted using the contralateral limb for set pressures. Patients were assessed by an independent research nurse who was blinded at two, four, eight and 12 weeks and six months. Leg circumferences, Oleruder-Molander ankle score, AOFAS, quality of life questionnaires, wound assessments and venous ultrasound were compared.

Results: AIS plus Aircast boot (n=44) and Tubigrip plus Aircast boot (n=46) ankle circumference as a ratio compared to contralateral side initially had similar results at four weeks for AIS group 1.00 compared to 1.08 for control. OMAS score for group treated with AIS of 43 (four weeks) to 88 (12 weeks) was improved compared to Tubigrip group: 24 (four weeks) to 58 (12 weeks). At six months, the OMAS was 98 for the study group and 67 for the control group. Pain control at six months was 97 percent for the study group versus 33 percent for the control. Ninety-five percent of AIS had no limitation compared to 63 percent of the Tubigrip group. All in the AIS group were able to walk six blocks, while only 81 percent of the Tubigrip group were able to. SF12 score at four weeks for the AIS group was 83, while for the Tubigrip group, it was 74. Wound inspection score (high score indicates poor healing) AIS 1.55 in 12 patients compared to 3.27 in the 16 of the Tubigrip group. Painkillers were discontinued at 40 days for AIS and 52 days for the Tubigrip group. Return to work and normal activities at weeks 40 and 52 respectively for AIS, 52 and 70 days for Tubigrip. Duplex imaging at four weeks, five incidences of DVT for AIS and 10 in control.

Conclusion: In this study, the application of AIS with Aircast boot in the early stages of injury or postoperative care statistically improved outcomes in functionality, satisfaction, return to activity and decreased rate of DVT when comparing tubigrip with Aircast boot. Further studies would be interesting to compare the initial jones compressive dressing compared to AIS. In conclusion, this study reiterates the importance of edema control with healing, ROM and DVT prevention. Although the applicability of available compression stocking is limiting, further studies should compare the standard compressive dressings to the use of AIS.         

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