Management of Posttraumatic Swelling in Association with Conservative Treatment of Talo-Crural and Talo-Calcanear fractures

From June to August 2000, we studied the effect of closed functional stabilisation treatment on the development of posttraumatic swelling. 129 patients with nondisplaced talo-crural and talo-calcanear fractures, selected for closed treatment, were randomised into three groups. The first group was treated by traditional Plaster of Paris immobilisation (PoP). In the second group the patients were treated with a similar PoP for the first five days, immediately followed by Soft Cast (3M Healthcare TM) /Combicast application (hereafter Combicast) for the rest of the treatment time. In the third group the Combicast technique was applied immediately on admission. The effects of the three different treatment strategies on the posttraumatic swelling were measured following the modified method from Whitesides (13). The tissue pressure was measured on admission, 72 hours after initial immobilisation and on days 7, 14 and 21. Tissue pressure measuring was expressed in mmHg. An increase of tissue pressure in the fractured area was recorded after 72 hours in groups one and two with the traditional PoP. In group one a decrease of the tissue pressure could only be recorded after 14 days, which was remarkably later than we expected. In group two the tissue pressure started to decrease after application of Combicast on day 5. Instead of an increase we recorded a remarkable decrease of the posttraumatic swelling after 72 hours in group three following the application of Combicast at the start of the fracture treatment. Where in the other groups a relatively high tissue pressure was still measured after 7 days, in group three tissue pressure was back to normal again. Introduction As a result of violent forces, the posttraumatic swelling, following damage of bone and soft tissues,in addition to a disturbance of the arterial and venous circulation, lead to severe pain for the patient. It is obvious that an increase of the post traumatic swelling during the first days, can cause a risk of further constriction of the circulation. With prolonged posttraumatic swelling in the fracture area, pain for the patient will also be prolonged, which results in involuntary immobilisation, eg. nonfunction with all its consequences. These complications are especially expressed in the conservative treatment with a traditional immobilisation. In case of a prolonged swelling period the high tissue pressure and disturbance of the arterial and venous circulation can be a reason for delayed biological fracture healing, including other effects like complications with ischaemic disturbances and all its consequences. As both closed and open repair of fractures are of equal importance, both are worthy of further development. Closed management of fractures and ligament lesions with Combicast techniques resulting in good patient outcome has been described in several papers.(2, 3, 4, 5, 6) The aim of our study was to examine the effects on the development of posttraumatic swelling of Combicast compared with traditional plaster cast