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New technique offers alternative to surgery for older patients with unstable ankle fracture

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Older adults with unstable ankle fracture could avoid surgery through the use of a new plaster cast technique known as close contact casting, a UK study suggests.

The new technique offers a close anatomical fit and minimal padding, with the cast applied by a surgeon under anaesthetic.

The study published in the Journal of the American Medical Association compared close contact casting with traditional surgery to pin a broken ankle. The research team was led by the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS) at the University of Oxford.

Professor Keith Willett, of NDORMS and the Kadoorie Centre for Critical Care Research and Education at 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. However, we know that older patients have disproportionately poor outcomes, and their quality of life can suffer as they lose mobility.”

Surgery for ankle fracture, especially in older people, is often complicated by poor implant fixation, wound healing problems and infection, Professor Willett explained.

The study involved 620 patients at 24 UK hospitals, all of whom would usually have had surgery and who were randomly allocated to receive either surgery (309 patients) or a close contact cast (311 patients).

After six months, there was no significant difference between the groups for pain, ankle motion or mobility. 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.

Additionally, results showed that the close contact cast group reported fewer adverse events, with 71 compared with 116 for the surgery group.

Close contact casting required less time in the operating theatre, but more outpatient consultations and use of hospital transport. All patients spent a similar amount of time in hospital and to get back on their feet.

The researchers concluded that close contact casting may be an appropriate alternative treatment to surgery for older adult patients with unstable ankle fracture.