title: 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 with Ice.
abstract: BACKGROUND
  After ankle and hindfoot fractures, edema has a major impact on the time for surgical intervention and may increase the risk of wound complications and infection postoperatively. The aim of this study was to evaluate the efficacy of multilayer compression and intermittent impulse compression therapy in reducing ankle and hindfoot edema compared with the standard treatment with elevation and ice.
  
  
  METHODS
  This was a randomized, controlled, single-blinded clinical trial using a repeated-measures design. Fifty-eight patients with unilateral fractures of the ankle or hindfoot were randomized into the cold pack (control) group, the bandage group, or the impulse compression group and were analyzed according to the intention-to-treat principle. The primary outcome was the reduction of edema as measured with the figure-of-eight-20 method.
  
  
  RESULTS
  Preoperatively and postoperatively, there were significant differences in edema reduction between the bandage group and the control group. After two days of intervention, the median preoperative edema reduction in the control group was -2.0 mm (-5%) compared with -11.0 mm (-23%) in the bandage group (p < 0.017), and -0.3 mm (0%) in the impulse compression group (p > 0.017). Postoperatively, after two days, the median edema changes were +3.5 mm (+7%) in the control group compared with -7.3 mm (-22%) in the bandage group (p < 0.017) and +5.0 mm (+46%) in the impulse compression group (p > 0.017).
  
  
  CONCLUSIONS
  Multilayer compression therapy results in a faster reduction of ankle and hindfoot edema, although with less ankle dorsiflexion on postoperative day three than the control group, and can be recommended as an alternative treatment. Intermittent impulse compression applied without any extra compression by stockinette or bandage and without elevation in off-session periods cannot be recommended as a superior alternative to the treatment with ice.
  
  
  METHODS
  Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.
authors.affiliation: Departments of Rheumatology and Physiotherapy (M.R.-S.) and Trauma Surgery (M.R.-S., P.H., and R.B.), Lucerne Cantonal Hospital, Spitalstrasse, 6000 Lucerne 16, Switzerland. E-mail address for M. Rohner-Spengler: manuela.rohner@luks.ch.
authors.forename: Manuela
authors.initials: M
authors.lastname: Rohner-Spengler
authors.affiliation: Clinical Trial Unit, Swiss Paraplegic Centre, Guido A. Zäch Strasse 1, 6207 Nottwil, Switzerland.
authors.forename: Angela
authors.initials: A
authors.lastname: Frotzler
authors.affiliation: Departments of Rheumatology and Physiotherapy (M.R.-S.) and Trauma Surgery (M.R.-S., P.H., and R.B.), Lucerne Cantonal Hospital, Spitalstrasse, 6000 Lucerne 16, Switzerland. E-mail address for M. Rohner-Spengler: manuela.rohner@luks.ch.
authors.forename: Philipp
authors.initials: P
authors.lastname: Honigmann
authors.affiliation: Departments of Rheumatology and Physiotherapy (M.R.-S.) and Trauma Surgery (M.R.-S., P.H., and R.B.), Lucerne Cantonal Hospital, Spitalstrasse, 6000 Lucerne 16, Switzerland. E-mail address for M. Rohner-Spengler: manuela.rohner@luks.ch.
authors.forename: Reto
authors.initials: R
authors.lastname: Babst
mesh_terms: D064386:Ankle Fractures / Q000150:complications*; D058128:Compression Bandages; D004487:Edema / Q000209:etiology* / Q000628:therapy*; D050723:Fractures, Bone / Q000150:complications; D006801:Humans; D007053:Ice; D048228:Intermittent Pneumatic Compression Devices; D011183:Postoperative Complications / Q000628:therapy*; D011446:Prospective Studies; D016037:Single-Blind Method; D013639:Tarsal Bones / Q000293:injuries*; D016896:Treatment Outcome
chemical_list: D007053:Ice