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Older patients with unstable ankle fractures ‘could avoid surgery’

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Older patients with unstable ankle fractures could avoid surgery using a new type of plaster cast, according to research led by Oxford University.

A study, published in the Journal of the American Medical Association, compared surgery to pin a broken ankle with a new plaster cast technique known as “close contact casting”.

“Close contact casting may be an appropriate treatment for older adults”

Keith Willett

Until now, patients with unstable fractures either received open surgery to set and then fix the bones using plates and screws, or they received a traditional plaster cast.

The researchers set out to assess whether a new casting technique could reduce the need for surgery while avoiding the drawbacks of traditional casts.

Close contact casting uses less padding than a traditional cast and sets the bones by being a close anatomical fit. The cast is applied by a surgeon under anaesthetic.

The new study involved 620 patients at 24 hospitals, all of whom would usually have had surgery and who were randomly allocated to either surgery or to receive a close contact cast.

“Older adults – those over 60 – are suffering an increasing number of ankle fractures”

Keith Willett

Each patient was assessed six weeks and six months after treatment. After six months, there was no significant difference between the groups for pain, ankle motion or mobility, the study found.

Patients were also given three questionnaires – the Olerud-Molander Ankle Score (specifically designed to assess progress in recovery from ankle injury) and the EQ-5D and SF-12 quality of life surveys.

The average scores from these three questionnaires were also the same between the groups, said the researchers.

They highlighted, however, that surgery led to more adverse events, with 116 reported compared to 71 for the close contact cast group.

University of Oxford

Study backs ‘close contact casting’ for unstable fractures

Close contact casting

Close contact casting also used less time in the operating theatre – around 54 minutes less per patient – but it required more outpatient consultations and use of hospital transport.

The overall time that patients spent in hospital and then to get back on their feet was similar for the two treatment techniques.

Study author Professor Keith Willett, from Oxford University and Oxford University Hospitals NHS Foundation Trust, said: “Older adults – those over 60 – are suffering an increasing number of ankle fractures from leading more active lifestyles and the rising prevalence of osteoporosis.

“Overall, this study indicates that close contact casting may be an appropriate treatment for older adults, reducing the level of resources needed for treatment and avoiding some of the common complications of surgery,” he said.

Keith Willett

Keith Willett

Keith Willett

He added: “Traditional plaster casts are associated with misaligned bones, poor healing and plaster sores. Surgery, especially in older people, is often complicated by poor implant fixation, wound healing problems and infection.”

Professor Willett noted a Cochrane review of evidence for or against a medical technique or treatment could not recommend preferring either treatment.

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Readers' comments (1)

  • Ankle fractures are associated with severe post injury swelling which often precludes the use/application of a closed cast.

    The information published here does not give insight into how post trauma swelling is managed or at what point a close contact cast is applied.

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