A research letter from a study conducted in the United Kingdom and published in the March 27, 2018, issue of The Journal of the American Medical Association suggests that close contact casting or surgical treatment of unstable ankle fracture may offer equivalent ankle function for older adults. 

The authors conducted a randomized clinical trial of 428 patients older than 60 years, 206 of whom were treated with casting and 222 of whom were treated with surgery. At median three-year follow-up, they found no significant difference across cohorts in Olerud and Molander Ankle Score, quality of life, or pain. Overall, 17 patients in the casting cohort (8 percent) and 22 patients in the surgical cohort (10 percent) underwent surgery after six months. Five patients in the casting group underwent internal fixation for nonunion after six months. In post hoc analysis, the authors found that the mean total operating room procedures per participant (per protocol) were 1.3 in the casting group and 1.2 in the surgery group, while mean total surgical procedures per participant were 0.3 in the casting group and 1.2 in the surgery group. Learn more...

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