If you've ever damaged your ankle and spent weeks hobbling around in a cast while it healed, we have some deeply annoying news. You could probably have been out of the cast in half the time and healed as well or better. The new finding raises questions as to how many other body parts are also being immobilized for longer than is necessary, the cumulative inconvenience of which adds up to a significant chunk of people's lives.
Not all medical treatment’s protocols are based on solid research. There have been plenty of studies comparing the benefits of wearing a cast for bone fractures compared to other options, but how long the cast is needed hasn't had the same attention. Instead, six weeks has been chosen based on biological plausibility
Dr Tero Kortekangas of Finland's Oulu University Hospital noted casts come with a cost. The longer a limb is immobilized the greater the chance of skin damage, deep vein thrombosis, and stiffness after release. Then there is the physical inconvenience of someone trying to get on with life.
Kortekangas enrolled a group of patients who had suffered the most common sort of ankle fracture, but didn’t require surgery. A third of patients were assigned to wear a cast for three weeks, a third made do with an ankle brace, while the rest wore the cast for the traditional six weeks.
A year after the injury, those who had worn the cast for six weeks actually had the worst outcomes, with an average score of 87.6 on a healing measure, compared to 91.7 for those whose cast came off after three weeks. Those wearing a brace fell in between, but the differences were not statistically significant. On measures of pain, and quality of life all three groups were equal by this point, while those given the brace had somewhat greater ankle movement.
Unless you're Chris Pratt’s character in Parks and Recreation, you're probably keen to get the cast off as soon as possible. These results, published in the British Medical Journal suggest people are being partially incapacitated for at least three unnecessary weeks to end up with similar, or even slightly worse, outcomes at the end.
Three weeks is not so much to lose, and ankle fractures are not particularly common. Kortekangas and co-authors note the 247 participants account for a large proportion of Finns over the age of 16 injured in this way during the trial period, although those with a history of previous fractures or ligament injuries to their ankle were excluded.
However, the implications may be much more widespread. People with a variety of bone injuries may be spending more time than needed lugging around large lumps of plaster, simply because no one checked.