Wound Complications after Cast Immobilization compared to Early Functional Treatment in Surgical Fixation of Ankle Fractures: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Anne Wikje Spaans; Thomas P.A. Baltes; Floris S. F bij de Weg; Robert K. Wagner; Stein J. Janssen

doi:10.1016/j.injury.2026.113230

April 1, 2026InjuryOpen Access

Wound Complications after Cast Immobilization compared to Early Functional Treatment in Surgical Fixation of Ankle Fractures: A Systematic Review and Meta-analysis of Randomized Controlled Trials

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Key Points

This review aims to compare wound complication rates between cast immobilization and early functional treatment in surgical ankle fractures.
Conducted a systematic search in PubMed, Embase, and Cochrane libraries from 2000 to 2025.
Included randomized controlled trials that compared cast immobilization with early functional treatment after ankle surgery.
Assessed methodological quality using RoB-2 tool for randomized trials.
Analyzed primary outcome as overall incidence of wound complications and secondary outcomes for specific types.
Total of 10 trials with 1142 patients; 544 in cast group, 598 in early functional treatment group.
Wound complications in 6% of cast group vs. 14% in functional group (RR 2.14).
Impaired wound healing rates were 2% for cast vs. 4% for functional treatment (RR 2.03).
Superficial infection rates were 4% for cast vs. 8% for functional treatment (RR 1.87).
No significant differences for deep infections or wound-related reoperations.

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Implication

Systematic review compares wound complications in ankle fractures with cast immobilization and early functional treatment, indicating better outcomes with casts.

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Spaans et al. (2026) studied this question.

synapsesocial.com/papers/69d34d5c9c07852e0af97498 https://doi.org/10.1016/j.injury.2026.113230

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Wound Complications after Cast Immobilization compared to Early Functional Treatment in Surgical Fixation of Ankle Fractures: A Systematic Review and Meta-analysis of Randomized Controlled Trials

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Discussion

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Wound Complications after Cast Immobilization compared to Early Functional Treatment in Surgical Fixation of Ankle Fractures: A Systematic Review and Meta-analysis of Randomized Controlled Trials

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