SLR - October 2014 - Manasi Meghpara

Effective Treatment of Posttraumatic and Postoperative Edema in Patients with Ankle and Hindfoot Fractures

Reference: Rohner-Spengler M, Frotzler A, Honigmann P, Babst R. Effective treatment of posttraumatic and postoperative edema in patients with ankle and hindfoot fractures; a randomized controlled trial comparing multilayer compression therapy and intermittent impulse compression with the standard treatment of ice. Journal of Bone and Joint Surgery-Am Vol.96-A, No.15, 1263-71.

Scientific Literature Review

Reviewed By: Manasi Meghpara, DPM
Residency Program: New York Hospital, Queens NY

Podiatric Relevance: Ankle and hindfoot fractures are commonly associated with posttraumatic, preoperative and postoperative edema. Prevention of pedal edema has gained importance as it can influence surgical outcome, risk of postoperative complications and wound infections. Although use of ice and elevation is the standard and widely accepted treatment, its effect in edema reduction is still controversial. The aim of the study was to evaluate the difference between three treatment methods i.e. Multilayer compression, impulse therapy, and standard ice and elevation on reduction of edema in patients with ankle and hindfoot fractures in an acute inpatient trauma setting. The authors state that there are no previous randomized controlled trails comparing effects of these different treatment modalities.

Methods: Study design consisted of a prospective randomized, controlled single blinded study of 58 patients with unilateral ankle or hindfoot fracture who were seen in emergency department between January 2007 and January 2009. Patients were divided in three groups, Control Group [4 ice gel pack with elevation], Bandage Group [22 hours compression with two hours removal] and Impulse Compression Group  via A-V impulse system [130mm hg for one sec every 20 sec]. Fracture stabilization was achieved via a custom made orthosis. Changes in edema reduction for each group were measured five days preoperatively and five days postoperatively. Primary and secondary outcomes were also measured during the study period.

Results: Statistically significant difference in edema reduction was observed preoperatively and postoperatively in the Bandage Group as compared to Impulse Compression and Control Group after two days. Preoperatively, a reduction of -23 percent in Bandage Group was noted as opposed to -5 percent in Control Group and 0 percent in Impulse Compression Group. Postoperatively, a reduction of -22 percent in bandage group was noted, while an increase of 7 percent in control and 46 percent in intermittent compression therapy group was noted. Although after three days, results were more pronounced in the Bandage Group; a decrease in ankle dorsiflexion was noted. Results were not significant in the control and impulse compression group after three days, but patients reported less pain preoperatively as compared to bandage group.

Conclusion: Multilayer compression therapy may significantly reduce edema in patient with ankle and hindfoot fractures as compared to intermittent impulse compression therapy and standard ice and elevation. Intermittent compression therapy alone without the use of extra compression, bandage or elevation cannot be recommended as an alternative therapy and yielded no superior benefits over the standard treatment. Overall, the authors concluded that multilayer compression could be used as an alternative treatment in acute trauma settings.

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