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Journal update monthly top five
  1. Charles Reynard1,2,
  2. Gabriella Prager3,
  3. Govind Oliver1,
  4. Anisa Jabeen Nasir Jafar4,
  5. Mina Naquib5,
  6. Richard Body1,2,
  7. Simon David Carley1,6
  1. 1 Emergency and Intensive Care Research Office, Manchester Royal Infirmary, Manchester, UK
  2. 2 Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
  3. 3 Emergency Department, Bolton NHS Foundation Trust, Bolton, UK
  4. 4 Humanitarian and Conflict Response Institute, The University of Manchester, Manchester, UK
  5. 5 Paediatric Emergency Department, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
  6. 6 Postgraduate Medicine, Manchester Metropolitan University, Manchester, UK
  1. Correspondence to Dr Charles Reynard, Emergency Department, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK; charlie.reynard{at}

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This month’s update is by the core editorial team based out of the EMERGING research group from Manchester. We used a multimodal search strategy, drawing on free open access medical education resources and literature searches.1 We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.

The papers are ranked as follows:

  • Worth a peek—interesting, but not yet ready for prime time.

  • Head turner—new concepts.

  • Game changer—this paper could/should change practice.

Use of cast immobilisation versus removable brace in adults with an ankle fracture: multicentre randomised controlled trial

Topic: Fractures

Rating: Head turner

‘Broken-bone’ research almost feels antiquated in the pandemic era; however, here is an emergency medicine study reminding us of the good old days! The title is a giveaway, but briefly this is multicentre (20 UK trauma units), superiority, randomised controlled trial recruiting patients with ankle fractures that clinicians would opt to place in a 3-week cast2. The standard arm comprised a below-knee cast plus ankle exercises (once cast removed); the intervention arm comprised a removable brace plus verbal/written encouragement to undertake ankle exercises as soon/often as pain allowed.

Following an intention-to-treat analysis, the primary outcome measure was the Olerud-Molander Ankle Score (OMAS) at 16 weeks. Planned secondary outcomes were complications, resource-use, quality-of-life measures and functional scores.

Six hundred sixty-nine randomised patients were included. The headline result was no statistically significant difference in the OMAS at 16 weeks (mean difference 1.8, 95% CI −2.0 to 5.6). While the study was not powered for the secondary outcomes, among the subgroup who ultimately had operative management, more patients in the brace group had wound infection/breakdown. No difference was found in the resource usage.

On the face of it, this study suggests that brace versus cast …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; internally peer reviewed.