After ankle fracture surgery: weak evidence for faster weight-bearing capacity of the foot with CAM training

After surgery for a fracture of the ankle, independent training with an active controlled motion device, also called controlled active motion (CAM) splint, could offer more advantages than standard care (physiotherapy) without a CAM splint: A single small study on this topic in 50 adult patients showed that discomfort of the injured ankle can be reduced after CAM training and that the foot can bear weight again more quickly.

However, there are no studies on the use of CAM splints in patients with conservative treatment. If, with conservative treatment, the injured ankle is at least partially able to bear weight again, the results of the above-mentioned study can probably be transferred to this subpopulation.

The benefit assessment on CAM splints conducted by the Institute for Quality and Efficiency in Health Care (IQWiG) on behalf of the Federal Joint Committee (G-BA) has now been completed. The overall conclusion is that, in adults with an ankle fracture, the data provide a hint of a benefit for a CAM splint used independently by the patient versus standard care, both after surgery and after conservative treatment with partial weight-bearing capacity of the injured ankle.

However, the available evidence is weak. A confirmatory randomized controlled trial should therefore be considered in patients with this condition, which is common and not life threatening.

Treatment goal: restore the joint and mobilize quickly

In 2018, around 64,000 ankle fractures were treated in German hospitals. Patients are on average 56 years old. Acute and follow-up treatment of a fracture of the upper ankle is intended to restore joint function as far as possible without limitations. Conservative or surgical treatment, which immobilizes the joint for some time, is usually followed by subsequent treatment with physiotherapy in order to mobilize the joint again as quickly as possible. Active motion splints or CAM splints are "pedalling machines" in which (depending on the manufacturer) only the injured foot or both feet are fixed and actively trained by a mechanically guided movement. This training can also be performed independently at home.

Procedure of report production

In June 2021, IQWiG published the preliminary results, the preliminary report, for discussion. After completion of the commenting procedure, the project team revised the preliminary report and in October sent the final report to the contracting agency, the G-BA. The written comments received are published in a separate document at the same time as the final report.

An extract of the final report will be soon be published in English. If you would like to be informed when it is published, please contact info@iqwig.de.