FIRST ANKLE SPRAIN IN PAEDIATRICS: EXCELLENT RESULTS AT 12 MONTHS WITH SYSTEMATIC MANAGEMENT

A recent systematic review reveals that a significant percentage of patients have residual symptoms 12 months after a first ankle sprain (such as persistent instability and chronic pain). Since this injury often occurred in sports activities and is more frequent in an adolescent population, it is important to understand if those numbers also apply to the pediatric patients. The objective of this study was to evaluate the outcome of a pediatric population at least 12 months after a first ankle sprain.The hypothesis is that the pediatric population, after following a systematic protocol for ankle sprain, will have a low percentage of persistent symptoms at 12 months post ankle sprain. A prospective cohort study was conducted which included patients ranging from 12 to 18 years of age who presented with a first ankle sprain at the emergency room. During the initial visit, sociodemographic data and injury history were collected through a basic questionnaire. A systematic physical examination and a quality-of-life questionnaire, the Foot and Ankle Measure (FAAM) were administered up to six times between the first visit and the last, at least one year after the injury. Routine radiographs were done at first visit for all patients to rule out fracture and a systematic rehabilitation protocol was started with a walking boot, protected weight bearing with crutches and physical therapy. The second visit was within 2 weeks of the injury and completed by an orthopedic surgeon. At this visit, the clinician determined the severity of the sprain by the level of residual swelling, painful palpation of the syndesmosis, a positive squeeze test or external rotation test, painful weight-bearing, in short, the level of clinical suspicion was set at the lowest possible level to classify patients in the complex sprain group. Descriptive statistics on the cohort were performed, and a comparison of FAAM scores at the last visit between the simple and complex sprain groups was made with t-tests. A total of 68 patients were recruited (28 male, 40 female). Forty-four were assign to the simple ankle sprain and 24 in the complex ankle sprain at their second visit. The mean follow-up time was 18 ± 5 months and the mean FAAM at this last visit was 96 ± 7. There was a statistical difference between the simple sprain (99 ± 2) and complex sprain (97 ± 7) for the functional component (p= 0.018) and for the sport activity component (simple (97 ± 5) vs complex (94 ± 12) p=0.016) but there was no significant difference for the overall score. In conclusion, in the paediatric population presenting to the emergency department for a first episode of ankle sprain, the outcome at over 12 months follow-up is excellent, with very little functional impairment overall. Systematic management of all sprains with a walking boot and physiotherapy program certainly helped to achieve these results.