Study Summary

243 adults undergoing ankle fracture fixation were randomized to plaster cast or removable boot at two weeks postoperatively. Of these, 173 completed the primary outcome within the predefined time window and were analyzed. The primary outcome was Olerud and Molander Ankle Score (OMAS) at seven weeks. Secondary outcomes included OMAS at 12 weeks, range of motion (ROM), quality of life (QoL), complications, return to function, and patient experience through qualitative interviews. Overall, the results of the study revealed no statistically significant or clinically meaningful difference in OMAS at seven weeks. The boot group demonstrated greater dorsiflexion and plantarflexion at six weeks, particularly in comminuted fractures and patients ≥ 65 years. Complications were more frequent in the boot group, although most were minor. These findings suggest similar short-term functional recovery between strategies, with modest ROM advantages but a higher minor complication rate in the boot group.