Edema control after ankle- and hindfoot fractures is important. Multi-layer compression bandages or A-V Impulse compression may are more effective in reducing edema than ice.
After ankle- and hindfoot fractures, edema has a major impact on the time point of surgical intervention and may increases the risk of wound complications and infection postoperatively. Effective treatment of edema, therefore, is of great importance. The aim of this study was to evaluate the efficacy of the multi-layer compression therapy and of the A-V Impulse compression (AVI) in reducing ankle- and hindfoot edema as compared to the standard treatment with ice.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
64
ice gel pack combined with elevation
Application of a multi-layer compression bandage to the foot and lower limb (two layers of wool followed by several layers of a short stretch bandage).
A-V Impulse compression dosage: 130mmHg exerted to the sole of the foot for one second, every twenty second.
Luzerner Kantonsspital, Unfallchirurgie
Lucerne, Switzerland
Ankle edema as measured with the figure-of-eight20 method
The figure-of-eight20 is a validated method to measure ankle edema with a simple spring tape. The spring tape follows a figure of eight around the ankle joint.
Time frame: Participants were assessed daily for the duration of hospital stay, an expected average of 5 days preoperative and 5 days postoperative. Follow-up at 6 weeks postoperative.
Pain scores measured on the Visual Analogue Scale (VAS)
Visual Analogue Scales were used to assess a daily pain score reflecting strongest and average pain perceived during the previous 24 hours, night pain and pain frequency.
Time frame: Participants were assessed daily for the duration of hospital stay, an expected average of 5 days preoperative and 5 days postoperative. Follow-ups at 6 weeks, 12 weeks and 1 year postoperative.
Patient satisfaction with treatment scores measured on the Visual Analogue Scale
Visual Analogue Scales were used to assess patient satisfaction with the assigned treatment. The patients had to record their satisfaction with the treatment before surgery and after surgery.
Time frame: Participants were assessed for the duration of hospital stay, an expected average of 5 days preoperative and 5 days postoperative --> assessment at the day of discharge.
Number of days until possible operation
The surgeon daily had to assess whether the patient was ready for operation or not. The wrinkling test served as a criteria for decision making. Accordingly the number of days until possible operation was recorded.
Time frame: Participants were assessed daily for the duration of preoperative hospital stay, an expected average of 5 days.
Number of postoperative hospitalization days
Postoperatively the physiotherapist each day had to record whether or not the patient was ready for discharge. Discharge criteria: 1. patient is able to walk 20 meters and one flight of stairs with crutches. 2. the wound is dry and not irritated. Accordingly, the number of days of postoperative hospitalization until discharge criteria were reached was recorded.
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Time frame: Participants were assessed daily for the duration of postoperative hospital stay, an expected average of 5 days.
Range of motion of the ankle joint and foot.
Plantar flexion, dorsal flexion, inversion and eversion were assessed with a hydrogoniometer.
Time frame: Participants were assessed daily for the duration of postoperative hospital stay, an expected average of 5 days. Follow-up at 6 weeks postoperative.
Amount of daily intake of medication
The intake of daily pain medication was recorded for the instay period (Dafalgan, Novalgin, opiates). Furthermore, the patient file was screened for any Nonsteroidal anti-inflammatory drugs (not allowed).
Time frame: Participants were assessed daily for the duration of hospital stay, an expected average of 5 days preoperative and 5 days postoperative.
Number of adverse events as a measure of safety in each group
Adverse events were defined as: bacterial infection, implant breakage, secondary dislocations, massive wound complications, thrombosis, embolism.
Time frame: Participants were assessed daily for the duration of hospital stay, an expected average of 5 days preoperative and 5 days postoperative. Patient file was screened for adverse events until 1 year postoperatively.
Lower limb function (Foot and ankle ability measure)
Questionnaire, self-assessed by the patient. To assess function and participation.
Time frame: 12 weeks postoperative, 1 year postoperative.
General Health (SF-36)
Generic assessment of the health status with the SF-36.
Time frame: 12 weeks postoperative,1 year postoperative.
Patient satisfaction scores on overall outcome measured on the Visual Analogue Scale
Patients had to record on the VAS on how satisfied they were with the overall outcome.
Time frame: 12 weeks and 1 year postoperative.
Amount of volumetric lower limb edema
Measurements of circumference of the lower limb were used to calculate lower limb volume. The circumferences of the lower limb were measured in increments of 4 cm from ankle level until below the knee joint.
Time frame: Participants were assessed daily for the duration of hospital stay, an expected average of 5 days preoperative and 5 days postoperative. Follow-up at 6 weeks postoperative.
Number of complains of discomfort or intolerances considering the intervention
Every day the patients were asked by the physiotherapist if they had any sort of complains considering the assigned treatment (discomfort or intolerances).
Time frame: Participants were assessed daily for the duration of hospital stay, an expected average of 5 days preoperative and 5 days postoperative.