Sally L Bullock, Hilary M Winthrop, Derek Hales, Feng-Chang Lin, Yumei Yang, Alice S Ammerman, Anthony J Viera
Who chooses "healthy" meals? An analysis of lunchtime meal quality in a workplace cafeteria
BMC public health
ankle fractures usually occur twisting incident diverse collection injuries different levels complexity severity incidence 1 1000 year children treatment generally involves splints casts minor fractures surgical fixation screws plates pins followed immobilisation serious fractures assess effects benefits harms different interventions treating ankle fractures children searched cochrane bone joint muscle trauma group specialised register 22 september 2015 cochrane central register controlled trials central 2015 issue 8 medline 1946 september week 2 2015 medline inprocess nonindexed citations 21 september 2015 embase 1980 2015 week 38 cinahl 1937 22 september 2015 trial registers 17 february 2015 conference proceedings reference lists articles included randomised quasirandomised controlled trials evaluating interventions treating ankle fractures children two review authors independently screened titles abstracts full articles inclusion assessed risk bias collected data undertook metaanalysis included three randomised controlled trials reporting results 189 children clinical diagnosis low risk ankle fracture predominantly classified undisplaced salterharris type fractures distal fibula three trials compared nonsurgical management options three trials high risk bias primarily relating impracticality blinding participants treating clinicians allocated interventionstwo trials compared aircast airstirrup ankle brace versus rigid cast removable fibreglass posterior splint one trial trial belowknee fibreglass walking cast trial trial b trial devices removed around two weeks trial b removal brace optional five days walking cast removed three weeks lowquality evidence clinically important differences function scores four weeks favour brace groups trials function measured using activities scale kidsperformance askp score range 0 100 higher scores mean better function trial using modified version askp score range 0 100 higher percentages mean better function trial b results trial 40 participants median 919 brace group versus 842 splint group results trial b 104 participants 913 versus 853 mean difference md 600 favouring brace 95 confidence interval ci 138 1062 trial b indicated 5 amounted clinically relevant difference modified askp score neither trial reported unacceptable anatomy related outcomes longterm followup lowquality evidence relating adverse events none serious trial found twice many children pressurerelated complications brace group 10 20 versus 5 20 contrast trial b found four times many children cast group adverse outcomes assessed terms unscheduled visit healthcare provider 4 54 versus 16 50 trials linked adverse events brace group failure wear protective sock lowquality evidence indicating earlier return preinjury activity brace groups trials trial b provided lowquality evidence children much prefer five days wearing ankle brace three weeks immobilised walking ankle cast moderatequality evidence lack difference two groups pain four weeksthe third trial compared tubigrip bandage plus crutches advice versus plaster paris walking cast two weeks reported results four weeks followup 45 children inversion injury ankle trial found lowquality evidence little difference pain function two groups measured using nonvalidated pain function score four weeks trial report adverse effects lowquality evidence earlier return normal activities averaging six days children treated tubigrip mean 1417 days tubigrip versus 2019 days cast md 602 days 95 ci 892 312 daysrecent evidence magnetic resonance imaging studies main category injury evaluated three trials suggests injuries trials sprains bone bruises rather fractures distal fibular growth plate lowquality evidence quicker recovery self reported function four weeks children clinically diagnosed lowrisk ankle fractures treated ankle brace compared treated rigid cast especially nonremovable walking cast otherwise lack evidence randomised controlled trials inform clinical practice children ankle fractures research identify address priority questions treatment common fractures needed