Outcome of ankle fractures in children: an updated systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis of randomised controlled trials assessed non-operative immobilisation options for children aged 0–18 years with low-risk, stable or suspected occult ankle fractures. Seven trials involving 503 children were included. Compared with casts, removable boots or braces reduced unscheduled healthcare visits (RR 0.26; 95% CI 0.13 to 0.52; p = 0.0001), shortened return to normal activities and improved functional scores. Satisfaction was also higher with removable devices. Supportive bandaging showed some benefits, but results were heterogeneous; pain and complication rates did not differ significantly between groups.

Key findings

• Removable boots or braces reduced unscheduled healthcare visits versus casts (RR 0.26; 95% CI 0.13 to 0.52; p = 0.0001).
• Removable devices shortened return to normal activities (MD -6.83 days; 95% CI -11.20 to -2.96; p = 0.0031) and improved functional scores (SMD -0.79; 95% CI -1.03 to -0.55; p < 0.00001).
• Supportive bandaging reduced missed school days (MD -0.49; 95% CI -0.81 to -0.18; p = 0.002) and accelerated return to baseline activities (14.17 vs 20.19 days; p = 0.0002), with high heterogeneity.
• No significant differences were found between groups in pain, complications, emotional wellbeing or mobility.

Why it matters

For low-risk paediatric ankle fractures, immobilisation choice may affect recovery, healthcare use and patient or parent satisfaction. The review suggests removable devices can offer functional advantages over casts without detected differences in pain or complications. However, uncertainty about rigid versus soft immobilisation means the evidence does not establish a definitive approach.

What to keep in mind

The review included only seven RCTs, and results for supportive bandaging showed high heterogeneity. The authors state that a definitive RCT using a core outcome set and cost-effectiveness analyses is needed.