title: A randomized, controlled trial of a removable brace versus casting in children with low-risk ankle fractures.
abstract: OBJECTIVE
  Isolated distal fibular ankle fractures in children are very common and at very low risk for future complications. Nevertheless, standard therapy for these fractures still consists of casting, a practice that carries risks, inconveniences, and use of subspecialty health care resources. Therefore, the main objective of this study was to determine whether children who have these low-risk ankle fractures that are treated with a removable ankle brace have at least as effective a recovery of physical function as those that are treated with a cast.
  
  
  METHODS
  This was a noninferiority, randomized, single-blind trial in which children who were 5 to 18 years of age and treated in a pediatric emergency department for low-risk ankle fractures were randomly assigned to a removable ankle brace or a below-knee walking cast. The primary outcome at 4 weeks was physical function, measured by using the modified Activities Scale for Kids. Additional outcomes included patient preferences and costs.
  
  
  RESULTS
  The mean activity score at 4 weeks was 91.3% in the brace group (n = 54), and this was significantly higher than the mean of 85.3% in the cast group (n = 50). Significantly more children who were treated with a brace had returned to baseline activities by 4 weeks compared with those who were casted (80.8% vs 59.5%). Fifty-four percent of the casted children would have preferred the brace, but only 5.7% of children who received the brace would have preferred the cast. The cost-effectiveness acceptability curve was always >80%; therefore, the brace was cost-effective compared with the cast.
  
  
  CONCLUSIONS
  The removable ankle brace is more effective than the cast with respect to recovery of physical function, is associated with a faster return to baseline activities, is superior with respect to patient preferences, and is also cost-effective.
authors.affiliation: Division of Emergency Medicine, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8. boutis@pol.net
authors.forename: Kathy
authors.initials: K
authors.lastname: Boutis
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Willan
authors.forename: Paul
authors.initials: P
authors.lastname: Babyn
authors.forename: Unni G
authors.initials: UG
authors.lastname: Narayanan
authors.forename: Benjamin
authors.initials: B
authors.lastname: Alman
authors.forename: Suzanne
authors.initials: S
authors.lastname: Schuh
mesh_terms: D000293:Adolescent; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000191:economics / Q000628:therapy*; D001915:Braces / Q000191:economics; D002370:Casts, Surgical / Q000191:economics; D002648:Child; D003362:Cost-Benefit Analysis; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000191:economics / Q000628:therapy*; D006801:Humans; D017060:Patient Satisfaction / Q000191:economics; D011859:Radiography; D016037:Single-Blind Method