Ankle Fracture: Close Casting Can Be Alternative To Surgery For Older Patients Interview with:
David Keene DPhil
NIHR Postdoctoral Research Fellow
NDORMS Research Fellow in Trauma Rehabilitation
Critical Care, Trauma and Rehabilitation Trials Group
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences
University of Oxford What is the background for this study? What are the main findings? 

Response: Our clinical trial comparing close contact casting to the usual internal fixation surgery for unstable ankle fractures in older adults found that ankle function at six months was equivalent. There was more abnormal healing of the fracture seen on radiographs (malunion) in the casting group (15 percent, compared to 3 percent for surgery) so we aimed to investigate the ankle function outcomes in the longer term. We found that equivalence in ankle function between initial close contact casting and surgery was maintained at three years. What should readers take away from your report?

Response: Our findings indicate that close contact casting is an appropriate alternative treatment to surgery for older people with an unstable ankle fracture. These longer-term outcomes will help surgeons and patients to make informed decisions about the right course of action for them. What recommendations do you have for future research as a result of this work?

Response: Future research will explore if there are certain types of older patients that do well after close contact casting or surgery. Is there anything else you would like to add?

Response: It is worth highlighting that the initial close contact casting was applied in the operating room under anesthesia.

There were no conflicts of interest. 


Keene DJ, Lamb SE, Mistry D, et al. Three-Year Follow-up of a Trial of Close Contact Casting vs Surgery for Initial Treatment of Unstable Ankle Fractures in Older Adults. JAMA. 2018;319(12):1274–1276. doi:10.1001/jama.2018.0811

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Last Updated on March 31, 2018 by Marie Benz MD FAAD