Study Summary

One hundred twenty-six patients with unstable unimalleolar Weber B ankle fractures and a congruent mortise were randomized to receive cast immobilisation or surgery with open reduction and internal fixation followed by casting. The primary outcome of interest was the Olerud-Molander Ankle Score. Secondary outcomes included ankle function (FAOS), pain, quality of life (RAND-36), ankle range of motion (ROM), radiographic outcomes, and adverse events. Outcomes were assessed up to two years post-randomisation. Overall, the results of the study revealed that cast immobilisation was non-inferior to surgery in functional outcomes, with no significant differences in secondary outcomes. These findings suggest that non-operative management is an effective alternative with fewer complications.