jkfas Journal of Korean Foot and Ankle Society J Korean Foot Ankle Soc 1738-3757 2288-8551 Korean Foot and Ankle Society 10.14193/jkfas.2020.24.1.31 jkfas-24-31 Original Article Effect of Leg Elevation Height on Reduced Swelling of Patients of Postoperative Acute Ankle Fractures SeoDong-Kyo KangHyun Wook AhnDeug Suk ∗ SongJae-Seok † Department of Orthopedic Surgery, Gangneung Asan Hospital, University College of Medicine, Gangneung, Korea Department of Nursing, Gangneung Asan Hospital, Catholic Kwandong University College of Medicine, Gangneung, Korea Department of Preventive Medicine & Public Health, Catholic Kwandong University College of Medicine, Gangneung, Korea Corresponding Author: Jae-Seok Song Department of Preventive Medicine & Public Health, Catholic Kwandong University College of Medicine, 24 Beomil-ro 579beon-gil, Gangneung 25601, Korea Tel: 82-33-649-7469, Fax: 82-33-641-1074, E-mail: songjs@cku.ac.kr ORCID: https://orcid.org/0000-0001-5583-182X 03 2020 20 03 2020 24 1 31 36 01022020 06032020 06032020 Copyright © 2020 Korean Foot and Ankle Society 2020 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose

Leg elevation is known as an effective method for reducing leg swelling, and it has been routinely used in medical practice. However, the effect of swelling reduction in relation to the degree of elevation height is not known. This study evaluated the swelling of the leg after acute ankle fracture operations at two different elevation heights and the elevated leg heights were compared.

 Materials and Methods

A total of 66 patients with postoperative acute ankle fractures were classified into two groups depending on the presence of different leg elevation heights: high-elevated (HE, case) and low-elevated groups (LE, control). We checked leg swelling, pain, subjective satisfaction for the elevation device, and the American Orthopedic Foot and Ankle Society (AOFAS) score, and we retrospectively compared them between both the groups.

 Results

Leg swelling and pain were reduced in both groups. However, they did not show any significant differences between both the groups (p>0.05). Nineteen patients in the HE group replied with uncomfortable, while no patients in LE group did so. The AOFAS score at 1 year postoperatively did not show any significant differences between both the groups (p=0.46).

 Conclusion

High elevation of the leg after ankle fractures did not show a significant difference from low elevation in regard to leg swelling, pain, and function. Furthermore, high leg elevation resulted in discomfort during the postoperative period. Thus, low elevation with a pillow is enough for acute ankle fracture patients with little discomfort and satisfactory swelling reduction.

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(A) Elevated leg with cushion elevator (30 cm-height) and (B) pillow elevator (10 cm-height) on the bed.

Figure-of-eight method. Flexible tape runs through from the tip of lateral malleolus, tuberosity of navicular, base of fifth metatarsal bone, tip of medial malleolus, and then returns to tip of lateral malleolus. (A) Medial side; (B) lateral side.

Change of swelling in the ankle (A), calf (B), and visual analogue scale (VAS) (C) in both groups. All parameters were checked four times at 4-day, 2-week, 6-week, and one-year postoperatively. HE: high-elevated, LE: low-elevated.

Demographic Parameters and Distribution of Fractures in Two Groups

Variable HE group LE group p-value
Patient 32 34 –
Follow-up period (yr) 1 1 –
Mean age (yr) 53.9±15.0 (19.0∼76.0) 51.2±16.6 (29.0∼84.0) 0.09
BMI (kg/m2) 23.8±2.4 (18.5∼26.4) 24.2±3.2 (19.4∼28.1) 0.55
Sex ratio (male:female) 20:12 18:16 0.30
Left to right ratio 15:17 14:20 0.79
AO/OTA type (patients)     0.67
43A 6 7  
43B 1 2  
43C 1 2  
44A 11 8  
44B 12 15  
44C 1 0  

Values are presented as number only or mean±standard deviation (range).

HE: high-elevated, LE: low-elevated, −: not available, BMI: body mass index, AO/OTA: Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association.

Comparison of Ankle and Calf Swelling and VAS in Both Groups

Variable Postoperative day p-value
4-day 2-week 6-week 1-year
Ankle swelling (cm) 0.92
HE 55.0±3.7 (47∼61) 53.2±3.8 (46∼60) 53.2±4.0 (46∼62) 50.5±4.0 (42∼58)  
LE 55.7±3.9 (48∼63) 53.9±3.6 (47∼61) 53.2±3.4 (47∼60) 51.1±3.4 (44∼58)  
Calf swelling (cm) 0.21
HE 34.3±3.8 (26∼42) 32.5±3.5 (25∼40) 32.2±3.4 (24∼39.5) 31.2±3.3 (23∼38)  
LE 36.2±4.3 (28∼52) 34.5±4.5 (26∼51) 34.2±4.6 (25∼52) 32.7±4.5 (24∼51)  
VAS 0.28
HE 4.5±1.8 (2∼8) 2.8±1.6 (0∼6) 1.9±1.2 (0∼5) 0.3±0.4 (0∼1)  
LE 4.8±1.7 (2∼8) 2.3±0.9 (1∼4) 1.4±0.7 (1∼3) 0.2±0.4 (0∼1)  

Values are presented as mean±standard deviation (range).

VAS: visual analogue scale, HE: high-elevated, LE: low-elevated.

Comparison of Subjective Satisfaction about Elevation Height in Both Groups

Subjective satisfaction HE group LE group p-value
Very comfortable 6 9 < 0.001
A little comfortable 7 25  
A little uncomfortable 14 0  
Very uncomfortable 5 0  
Total patients 32 34  

Values are presented as number.

HE: high-elevated, LE: low-elevated.