Casting, surgery equivalent over long term for unstable ankle Fx

(HealthDay)—For older patients with acute unstable malleolar fractures, equivalence in function between close contact casting and immediate surgery strategies persists at three years, according to a research letter published in the March 27 issue of the Journal of the American Medical Association.

David J. Keene, D.Phil., from the University of Oxford in the United Kingdom, and colleagues conducted extended follow-up of a randomized clinical trial involving participants aged older than 60 years with acute unstable malleolar fractures from 24 U.K. centers who had received surgery or close contact casting. Using patient-reported postal questionnaires, data were collected for at least three years after randomization; data were included for 450 of 620 randomized participants (73 percent).

The researchers found that there was equivalent ankle function with surgery and casting (mean Olerud and Molander Ankle Score, 79.4 and 76.3, respectively). No significant differences were seen in quality of life or pain. Overall, 10 and 8 percent of surgery and casting participants had operations after six months, including removal of surgical implants, arthrodesis, arthroplasty, and infection-related procedures. The mean total operating room procedures per participant were 1.2 and 1.3 in the surgery and casting groups, respectively, and mean total surgical procedures were 1.2 and 0.3, respectively.

"Equivalence in function between casting and immediate surgery strategies was maintained at three years," the authors write.

One author disclosed financial ties to ZIMMER.