Data from a study conducted in the United Kingdom and published in the Oct. 11 issue of The Journal of the American Medical Association suggest that close contact casting or surgical fixation may offer similar short-term functional outcomes for older adults with unstable ankle fracture. 

The authors conducted a randomized trial with blinded outcome assessment of 620 patients treated with either a molded below-knee cast with minimal padding or surgical fixation, 593 of whom completed the study. Overall 579 of 620 patients received the allocated treatment, with 52 of 275 (19 percent) who initially received casting later converting to surgery. At 6-month follow-up, the authors found no significant difference in Olerud-Molander Ankle Score between casting and surgical cohorts, nor any significant difference in secondary outcomes such as quality of life, pain, ankle motion, mobility, and patient satisfaction. They noted that infection and wound breakdown, as well as additional surgical procedures, were more common in the surgical group. However, radiologic malunion was more common in the casting group. In addition, casting required less operating room time compared with surgery. Learn more...