ORIGINAL RESEARCH article
Front. Med.
Sec. Precision Medicine
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1594505
Removable Brace as a Viable Alternative to Cast Immobilization for Ankle Fractures: A Meta-Analysis of Randomized Controlled Trials
Provisionally accepted
- 1Changsha Medical University, Changsha, China
- 2Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
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Recent years have seen ongoing debate over the preferred method of immobilization for ankle fractures, specifically between removable braces and cast immobilization. To address this, we conducted a meta-analysis of prospective randomized controlled trials to compare the two approaches and assess the feasibility of using a removable brace as an alternative to cast immobilization.PubMed, Cochrane Library, Embase, and Web of Science were last searched on January 18, 2025, to identify comparative studies evaluating removable braces versus cast immobilization. Data were extracted and pooled, and a meta-analysis was conducted using Review Manager 5.4.We included 11 RCTs with a total sample size of 1,472 participants. There were no significant differences in the Olerud-Molander Ankle Score (OMAS) between the removable brace and cast immobilization groups, both in the short term at 6 weeks (MD 7.18, 95% CI -5.77 to 20.12, P=0.28), 12 weeks (MD 6.02, 95% CI -0.22 to 12.26, P=0.06), and in the long term at 24 weeks (MD 2.25, 95% CI -2.78 to 7.27, P=0.38), as well as beyond one year (MD 0.82, 95% CI -1.75 to 3.39, P=0.53). Compared to the cast immobilization group, the removable brace group showed similar rates of chronic regional pain (RR 0.74, 95% CI 0.14 to 3.94, P=0.73), nonunion (RR 0.96, 95% CI 0.17 to 5.46, P=0.96), and thrombosis (RR 0.46, 95% CI 0.20 to 1.10, P=0.08). Additionally, there was no significant difference in the incidence of wound infections when the brace was applied after primary wound healing (RR 1.63, 95% CI 0.87 to 3.03, P=0.13). In terms of return to work (RTW), the removable brace group showed a significantly shorter mean time to return to work (MD -17.17, 95% CI -33.00 to -1.34, P=0.03).Subgroup analysis revealed that the brace group achieved a better OMAS score at 12 weeks when early weight-bearing was permitted (MD 9.00, 95% CI 1.47 to 16.53, P=0.02).Overall, both braces and casts demonstrated comparable effectiveness in postoperative ankle function recovery and wound complications. However, braces offered an advantage in promoting early weight-bearing, which contributed to improved ankle function recovery. Additionally, the use of braces allowed patients to return to work earlier.
Keywords: Ankle Fractures, removable brace, Cast immobilization, Meta-analysis, Weight bearing
Received: 16 Mar 2025; Accepted: 09 Jul 2025.
Copyright: © 2025 Zhu, Li, Yi, Li and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lemei Zhu, Changsha Medical University, Changsha, China
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