A broken ankle is disabling for anyone, but for seniors it can mean a permanent reduction in quality of life. Part of the reason is that seniors are at higher risk from the surgery, pins and/or plates and screws involved in the traditional treatment for ankle fractures. A few years ago, patients who had a new nonsurgical treatment seemed to be doing as well as patients who had surgery at a checkup while their fractures were still healing. But would the nonsurgical treatment be just as good once ankles were healed—and afterward? Now, three years later, there’s a more definitive answer.
The original study, led by researchers from University of Oxford in England, compared older adults with ankle fractures (average age 71) who had the new nonsurgical treatment called close-contact casting with similar patients who had traditional surgery and found that, overall, both groups had equivalent levels of pain and mobility—at six months. However, pain and mobility are not determined just by how well bones are healing but also by soft tissue injury, including from surgery and the presence of metal implants. So the researchers wanted to check how close-contact casting compared with surgery long-term…and whether post-traumatic arthritis, common after a fracture, was more likely in either group and might cause later disability.
Of the 620 patients in the original study, 450 were available for follow-up. The good news is that at three years, fractures that were treated with close-contact casting had healed just as well as fractures treated with surgery. Both groups continued to have similar ankle function, levels of discomfort and quality of life. Slightly fewer patients in the casting group required follow-up surgery (8% vs. 10%)…and while there were very few infection-related complications in the surgical group, there were none in the casting group. There were also no differences in arthritis symptoms between the groups.
Close-contact casting involves the surgeon molding a tight-fitting, below-the-knee cast while the patient is under anesthesia. Because of the close fit, the pressure of the cast evenly distributes pressure around the fracture site to keep the fracture stabilized. (With traditional ankle fracture treatment, pins and plates keep the bones in place.) One advantage of the new casting method is that because the cast fits so closely that the leg and ankle can’t shift around inside—traditionally a cause of abrasion and sores—it doesn’t need the extra bulk and weight of padding. This makes the new type of cast lighter than traditional plaster casts, which helps with mobility.
The researchers concluded that while both surgery and close-contact casting ultimately led to equal results, healing just as well without surgery is better. They tried close-contact casting first with seniors because they are most likely to have surgical complications as a result of having more fragile skin and poor circulation. But based on its success, the researchers hope to study using the method on younger patients.