***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: BACKGROUND Ankle fractures requiring open reduction and internal fixation ( ORIF ) are common and place considerable burden on inpatient beds . ORIF can not be performed once the associated swelling is too excessive to permit tension-free wound closure . Where ORIF can not be performed before the onset of swelling in the first 24 - 48h , patients typically require up to 7 days of inpatient bed-rest and elevation to reduce swelling to an acceptable level for ORIF . The primary aim of this study was to determine whether delay to ORIF could be reduced with the pre-operative application of an intermittent pneumatic foot pump ( IPF ) . These devices were design ed as anti-embolic adjuncts , but have also been shown to be effective in the reduction of swelling . We compared 12 patients managed with an IPF to 12 matched historical controls who were not . No previous studies have addressed this question in unselected patients requiring ankle ORIF . METHODS We performed a retrospective , controlled , before and after study of 24 patients who underwent ankle ORIF at our orthopaedic unit .  Foot pumps were applied in the Accident and Emergency Department to ankle fracture patients requiring admission , and kept in place until ORIF . Data was collected from patient case notes for all patients . Patients were matched for age , gender , American Society of Anaesthesiologists ( ASA ) Grade , and pre-injury mobility . The primary outcome measure was time to surgery . We also recorded total hospital stay , and calculated cost savings . RESULTS Patients managed with IPFs had a statistically significant 50 % reduction in time from presentation to surgery compared to those managed without ( p=0.024 ) , and had a reduced hospital stay ( p=0.116 ) . This result ed in a net saving of £ 10,480 ( £ 953 per patient ) . CONCLUSIONS We conclude that foot pumps reduce the time to surgery and total hospital stay of patients requiring ankle ORIF , and are cost effective In this r and omised controlled trial , we evaluated the role of elastic compression using ankle injury stockings ( AIS ) in the management of fractures of the ankle . A total of 90 patients with a mean age of 47 years ( 16 to 79 ) were treated within 72 hours of presentation with a fracture of the ankle , 31 of whom were treated operatively and 59 conservatively , were r and omised to be treated either with compression by AIS plus an Aircast boot or Tubigrip plus an Aircast boot . Male to female ratio was 36:54 . The primary outcome measure was the functional Olerud-Mol and er ankle score ( OMAS ) . The secondary outcome measures were ; the American Orthopaedic Foot and Ankle Society score ( AOFAS ) ; the Short Form (SF)-12v2 Quality of Life score ; and the frequency of deep vein thrombosis ( DVT ) .  Compression using AIS reduced swelling of the ankle at all time points and improved the mean OMAS score at six months to 98 ( 95 % confidence interval ( CI ) 96 to 99 ) compared with a mean of 67 ( 95 % CI 62 to 73 ) for the Tubigrip group ( p < 0.001 ) . The mean AOFAS and SF-12v2 scores at six months were also significantly improved by compression . Of 86 patients with duplex imaging at four weeks , five ( 12 % ) of 43 in the AIS group and ten ( 23 % ) of 43 in the Tubigrip group developed a DVT ( p = 0.26 ) . Compression improved functional outcome and quality of life following fracture of the ankle . DVTs were frequent , but a larger study would be needed to confirm that compression with AISs reduces the incidence of DVT Sixty patients with foot or ankle trauma were r and omized and treated in three groups . In intermittent impulse compression , an air pad under the foot was inflated every 20 seconds , thus activating the venous foot pump . In continuous cryotherapy , ice water circulates between the ice box and the cold pad . The ice water was changed once per day . In st and ard therapy , the injured extremity was treated with cool packs , which were changed 4 times per day . Beginning at admission , every 24 hours the circumference was measured around the ankle , midfoot , and forefoot . After 24 hours of treatment , there was a 47 % reduction in swelling with the A-V Impulse System , 33 % with continuous cryotherapy , and 17 % with cool packs . After 4 days of postoperative treatment , the A-V Impulse System reduced the swelling by 74 % versus 70 % with continuous cryotherapy and 45 % with cool packs . Both new methods are preferable to cool packs . Because of the better preoperative results , the A-V Impulse System proved to be the most effective device Study Design .. Prospect i ve observational 1-year study . Objective .. To determine minimum clinical ly important difference ( MCID ) and substantial clinical benefit ( SCB ) of outcome measures in failed back surgery syndrome ( FBSS ) patients , as these metrics enable assessment of whether and when an intervention produces clinical ly meaningful effects in a patient . Summary of Background Data .. Several methods have been devised to quantify clinical ly important difference , but MCID and SCB for FBSS patients has yet to be determined . Methods .. Patients with persisting/recurrent low back pain ( LBP ) and /or leg pain after lumbar surgery who completed 16 weeks of treatment ( n = 105 ) at two hospitals in Korea from November 2011 to September 2014 were analyzed . Global perceived effect was used to determine receiver operating characteristic curves in visual analogue scale ( VAS ) , Oswestry disability index ( ODI ) , and short form-36 ( SF-36 ) in an anchor-based approach . Results .. MCIDs for ODI , LBP and leg pain VAS , physical component summary , mental health component summary ( MCS ) , and overall health scores of SF-36 were 9.0 , 22.5 , 27.5 , 10.2 , 4.0 , and 8.9 , and SCBs were 15.0 , 32.5 , 37.0 , 19.7 , 19.3 , and 21.1 , respectively . MCID and SCB area under the curve was ≥0.8 , and ≥0.7 , respectively . Conclusion .. LBP and leg pain VAS , ODI , and physical component summary of SF-36 may be used to measure responsiveness in FBSS patients . Level of Evidence : BACKGROUND After ankle and hindfoot fractures , edema has a major impact on the time for surgical intervention and may increase the risk of wound complications and infection postoperatively . The aim of this study was to evaluate the efficacy of multilayer compression and intermittent impulse compression therapy in reducing ankle and hindfoot edema compared with the st and ard treatment with elevation and ice . METHODS This was a r and omized , controlled , single-blinded clinical trial using a repeated- measures design . Fifty-eight patients with unilateral fractures of the ankle or hindfoot were r and omized into the cold pack ( control ) group , the b and age group , or the impulse compression group and were analyzed according to the intention-to-treat principle . The primary outcome was the reduction of edema as measured with the figure-of-eight-20 method . RESULTS Preoperatively and postoperatively , there were significant differences in edema reduction between the b and age group and the control group . After two days of intervention , the median preoperative edema reduction in the control group was -2.0 mm ( -5 % ) compared with -11.0 mm ( -23 % ) in the b and age group ( p < 0.017 ) , and -0.3 mm ( 0 % ) in the impulse compression group ( p > 0.017 ) . Postoperatively , after two days , the median edema changes were + 3.5 mm ( + 7 % ) in the control group compared with -7.3 mm ( -22 % ) in the b and age group ( p < 0.017 ) and + 5.0 mm ( + 46 % ) in the impulse compression group ( p > 0.017 ) . CONCLUSIONS Multilayer compression therapy results in a faster reduction of ankle and hindfoot edema , although with less ankle dorsiflexion on postoperative day three than the control group , and can be recommended as an alternative treatment . Intermittent impulse compression applied without any extra compression by stockinette or b and age and without elevation in off-session periods can not be recommended as a superior alternative to the treatment with ice . LEVEL OF EVIDENCE Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence Twenty-four patients with displaced ankle fractures awaiting surgery were r and omized to a study ( n = 11 ) or a control group ( n = 13 ) . In the study group , patients had a pulsatile cold compression ( PCC ) device applied to their ankle , and remained at bed rest with the extremity elevated while awaiting surgery . In the control group patients remained in a posterior molded splint instead of the PCC device . Baseline circumferential measurements of the ankle were obtained , followed by measurements at 24-hour increments to evaluate edema resolution . In addition , patient satisfaction with use of the PCC device was evaluated with a scale ranging from 1 to 4 . The median decrease of circumference in the study group compared to the control group was 0.5 cm vs. 0.1 cm at 24 hours ( p=0.005 ) , 0.9 cm vs. 0.4 cm at 48 hours ( p<0.001 ) , and 1.2 cm vs. 0.5 cm at 72 hours ( p=0.009 ) . The ratio of the decrease in circumference relative to the circumference of the normal ankle was significantly higher in the PCC group compared to the control group at all time points . All patients in the PCC group were satisfied with the device ( median satisfaction score = 4 ) . The PCC device was well tolerated and result ed in a significantly greater reduction of ankle circumference at 24 , 48 , and 72 hours after its application , compared to splinting and elevation alone . The PCC device facilitates edema resolution following ankle fractures We studied the epidemiology of ankle fractures prospect ively during 1 year in a population of about 200,000 . The overall incidence rate was 107 fractures per 10(5 ) person-years . Below the age of 50 , ankle fractures were commonest in men . After this age , females became predominant and the age-specific incidence rates decreased in both sexes . The main cause of fracture was falls ( 87 % ) , on the ground , on stairs or from a height . 137 fractures ( 55 % ) occurred in sports , play or other leisure activities . Most patients ( 64 % ) were walking , running or jumping at the time of injury . Alcohol and slippery surfaces were each involved in nearly a third of the cases . The distribution of the fractures according to both the Lauge-Hansen and the AO Weber classification systems were within the limits of previous series . Nearly half the patients were hospitalized and the fractures were operated on with osteo synthesis . Our findings indicate that ankle fractures are mainly caused by substantial trauma sustained during physical activity . Osteoporosis seems to be of minor importance We performed a prospect i ve r and omised controlled trial of the A-V Impulse System in 82 patients treated by hemiarthroplasty for subcapital fracture of the femoral neck . The incidence of proximal deep-vein thrombosis as assessed by Doppler ultrasonography was 23 % in the control group and 0 % in those using the device ( p less than 0.01 ) . Calf and thigh circumferences were measured in both groups at seven to ten days after operation . In the treatment group there was a mean relative reduction of postoperative swelling of the thigh by 3.27 cm ( p less than 0.001 ) and of the calf by 1.55 cm ( p less than 0.001 ) . The A-V Impulse System appears to be a safe and effective method of reducing the incidence of proximal deep-vein thrombosis , and of postoperative swelling In patients with foot and ankle trauma , surgery and postoperative mobilization are often delayed because of swelling . The aim of this study was to assess if intermittent impulse compression of the foot is better than the st and ard therapy of applying cool packs at intervals . For intermittent impulse compression the AV impulse device was used ( Novamedix Inc. ) . From May to November 1993 , 40 patients ( 20 ankle fractures , 8 ruptured ligaments , 6 calcaneal fractures , 4 distal tibial fractures , 1 talus fracture , 1 subtalar dislocation ) were prospect ively assigned at r and om to the two groups and treated . After 24 h of treatment , the patients with intermittent impulse compression of the foot showed an average reduction of swelling of 47 % around the ankle , midfoot and forefoot . With cryotherapy it was 17 % . After 4 days of treatment in the postoperative course the swelling subsided at a rate of 74 % with impulse compression and 45 % with cryotherapy . Intermittent impulse compression of the foot proved to be a highly effective method of treating post-traumatic and postoperative edema . It seems preferable to the st and ard therapy using cold packs Thirty patients with an acute Weber B or C ankle fracture were enrolled after signing an informed consent . Fifteen patients were r and omized to a control group where they received a posterior splint , ice , and elevation before surgery . Fifteen patients were r and omized to a pneumatic pedal compression group where they received the same treatment plus a pneumatic pedal compression device which was used full- 
    Output:
    
Conclusions Compression therapy has a beneficial effect on edema reduction and probably a positive effect on pain and ankle joint mobility , but with the method ological limitations in the included studies it is not possible to make a solid conclusion on the effect on wound healing , LOS and TTS