Regular vs Intermittent Dose Ibuprofen for the Treatment of Ankle Sprains in Children

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01092676
Recruitment Status : Unknown
Verified June 2010 by Lawson Health Research Institute.
Recruitment status was:  Recruiting
First Posted : March 25, 2010
Last Update Posted : June 4, 2010
Information provided by:
Lawson Health Research Institute

March 23, 2010
March 25, 2010
June 4, 2010
February 2010
February 2012   (Final data collection date for primary outcome measure)
  • Less Pain on Weight Bearing [ Time Frame: 4 days ]
    Pain Scale 0-10 Visual Analog Scale
  • Less Disability [ Time Frame: 4 days ]
    0-10 Visual Analog Scale
  • Less Pain on Weight Bearing [ Time Frame: 4 days ]
  • Less Disability [ Time Frame: 4 days ]
Complete list of historical versions of study NCT01092676 on Archive Site
  • Less Swelling [ Time Frame: 4 Days ]
  • Pain on Passive Motion [ Time Frame: 4 Days ]
  • Tenderness on examination [ Time Frame: 4 days ]
Same as current
Not Provided
Not Provided
Regular vs Intermittent Dose Ibuprofen for the Treatment of Ankle Sprains in Children
Regular vs Intermittent Dose Ibuprofen for the Treatment of Ankle Sprains in Children

Ankle sprains are common in children, and optimal pain management has not been determined.

We hypothesize that children age 7-17 years of age with acute ankle sprain randomized to receive regular dose ibuprofen will show a greater improvement in degree of pain,disability,swelling and tenderness four days following injury as compared to children who take ibuprofen only intermittently for pain relief during the same time period.

Acute ankle sprains are one of the most common musculoskeletal injuries in children and adolescents seeking medical attention. There are an estimated 2 million ankle injuries a year and they represent 20 percent of all sports injuries. Data from the National Hospital Ambulatory Medical Care Survey in 2000 showed approximately 1.375 million visits to emergency departments (ED) in the US due to ankle sprains. This represented about 1.3% of all ED visits. The majority of these injuries occur in young athletes. One epidemiological study showed the prevalence of ankle sprains to be 73% in athletes.

The majority of ankle injuries do not involve bony fractures, rather they involve the soft tissue structures of the ankle joint. An ankle sprain is a stretching, partial or complete tear of the ligaments of the ankle. The most common type of ankle sprain is a lateral sprain, usually caused by an inversion injury. Ankle sprains can be classified as a grade I to III, depending on the severity of the injury. A grade I injury is a slight stretching of the ligament; whereas, a grade III sprain is a complete tear of the ligament.

Treatment of ankle sprains is aimed at decreasing the pain and swelling and protecting the ankle ligaments from further injury. The most commonly used acute management strategy includes the RICE (Rest, Ice, Compression, Elevation) protocol. The pharmacologic treatment of ankle sprains however, remains somewhat unclear. Analgesia with acetaminophen was historically the treatment of choice. However, with the development of over the counter NSAID (non-steroidal anti-inflammatory drug) agents, these have become increasingly popular for the treatment of ankle sprains. NSAIDS are a heterogeneous group of drugs that have analgesic, anti-pyretic, and anti-inflammatory effects. They have been used extensively in both adults and children, with ibuprofen being the most commonly used NSAID in North America. The theoretical advantage of the anti-inflammatory action, in addition to the excellent safety profile in children, has made ibuprofen the treatment of choice for musculoskeletal pain in this population.

Controlled trials in adults of various NSAIDS in ankle sprains have shown mixed results. Although they have shown a beneficial effect compared to placebo, they have not consistently shown a benefit over other analgesic choices. Nonetheless, The American Academy of Orthopedic Surgeons recommends that NSAIDs be used to control pain and inflammation in the treatment of acute ankle sprains.

There is very little evidence for the pharmacologic treatment of ankle sprains in children. A study completed at our centre involving 80 patients with acute ankle sprains showed no beneficial effect of naproxyn over acetaminophen in the treatment of pain. However, a study from Ottawa looking at pain relief in all types of musculoskeletal injury, showed a benefit of ibuprofen over both acetaminophen and codeine for pain control. Despite the scant evidence of the benefit of NSAIDS in pediatric ankle sprains, the American Academy of Pediatrics suggests that NSAIDS "can help reduce swelling and pain" in the treatment of ankle sprains.

There currently are no guidelines recommending a dosing schedule of ibuprofen for acute ankle sprains in children. Whether regularly dosed ibuprofen is beneficial versus as-needed dosing of NSAIDs, remains unclear. Interestingly, an unpublished informal survey of the pediatric emergency physicians at the Children's Hospital of Western Ontario, revealed universal recommendations of RICE therapy and the use of ibuprofen for the treatment of ankle sprains. However, the recommendations for ibuprofen dosing varied widely from as-needed to regular dosing.

The purpose of this study is to examine if regular dosed ibuprofen has an advantage over as-needed dosed ibuprofen in the treatment of acute ankle sprains in children.

Not Applicable
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary Purpose: Treatment
  • Ibuprofen
  • Ankle Injuries
  • Drug: Ibuprofen Regular Dosing
    Regular dosing
  • Drug: PRN dosing Ibuprofen
    PRN dosing Ibupofen
  • Active Comparator: Regular Ibuprofen Dosing
    Regular Ibuprofen Dosing throughout 4 days of study
    Intervention: Drug: Ibuprofen Regular Dosing
  • Active Comparator: PRN Ibuprofen dosing
    As needed Ibuprofen dosing
    Intervention: Drug: PRN dosing Ibuprofen
Not Provided

*   Includes publications given by the data provider as well as publications identified by Identifier (NCT Number) in Medline.
Unknown status
Same as current
Not Provided
February 2012   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  • Ages 7-17 years who have suffered an isolated ankle sprain within the last 24 hours
  • Able to return for follow-up with research assistant in 4 days time

Exclusion Criteria:

  • Preexisting Metabolic bone disease
  • Bilateral ankle sprains
  • Fractured ankle as demonstrated on X-ray
  • Suspected Salter 1 fracture or syndesmosis injury
  • Other traumatic injuries
  • History of Gastric ulcers or renal disease
  • Known or suspected allergy/sensitivity to ibuprofen
  • Previous ankle sprain of affected ankle within last 6 months
Sexes Eligible for Study: All
7 Years to 17 Years   (Child)
Contact information is only displayed when the study is recruiting subjects
REB 15517 ( Other Identifier: Research Ethics Board Number )
Not Provided
Not Provided
Rodrick Lim, Children's Health Research Institute: LHRI
Lawson Health Research Institute
Not Provided
Principal Investigator: Rodrick Lim, MD,FRCPC,FAAP Lawson Health Research Institute
Lawson Health Research Institute
June 2010

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