Six-month function equivalent between casting & surgery for unstable ankle fracture

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
620 patients with an unstable ankle fracture were randomized to treatment with either close contact casting or internal fixation. The purpose of this study was to determine if functional outcome within the first 6 months after casting was equivalent to internal fixation. Secondary clinical and Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: National Institute of Health Research (NIHR) Health Technology Assessment program; AO Research Foundation
Conflicts: Royalties
Why was this study needed now?
The optimal treatment for unstable ankle fractures has yet to be identified, particularly among older adults. Drawbacks with internal fixation include the risk of postoperative complications and poor fixation quality, while conservative treatment may suffer from a greater risk of malalignment or poor fracture healing. A newly developed conservative option, close contact casting, may offer similar results to surgical fixation while reducing the risk of complications.
What was the principal research question?
Was close contact casting equivalent to internal fixation for the treatment of an unstable ankle fracture when assessed over a 6-month follow-up period?
Population: 620 patients, over the age of 60, with an unstable ankle fracture
Intervention: Close contact casting: Following closed fracture reduction, close contact casting was performed in the following steps: stockinette bandage (BSN Medical GmbH) was applied; foam pads (Hapla) were placed over the tibial crest, fibular head, calcaneus, Achilles tendon and metatarsal heads; Fleecy web roll (Hapla) was applied for the length of the cast; a nonoverlapping layer of Soffban Plus synthetic wool (BSN Medical GmbH) was applied; Plaster of Paris (BSN Medical GmbH) was applied; and a topcoat of Soft Cast Casting Tape (3M Health Ltd.) was applied. Cast was applied under general or spinal anesthesia
Comparison: Internal fixation: Participants underwent internal fixation according to local practice and surgeon preference.
Outcomes: The primary outcome was function measured on the Olerud-Molander Ankle Score. Secondary outcomes were the Short Form 12-Item General Health Survey, the EuroQoL 5 dimensions questionnaire, patient satisfaction, time to weight-bearing, ankle range of motion, the timed up-and-go (TUG) test, and radiographic evaluation to assess nonunion or malunion. The incidence of complications and adverse events were also recorded.
Methods: RCT
Time: Follow-up was scheduled for 6 weeks and 6 months.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.