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Randomised controlled trial
Close contact casting may result in similar outcomes compared with plate fixation for unstable ankle fractures in patients over 60 years old
  1. Alastair Younger
  1. Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to: Professor Alastair Younger, Department of Orthopaedics, University of British Columbia, 560 1144 Burrard Street, Vancouver, BC, Canada V6Z 2A5; asyounger{at}

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Surgery has been considered the mainstay of treatment for unstable ankle fractures. Early mobilisation and weight bearing is possible with stable anatomic fracture fixation (open reduction internal fixation (ORIF)). Surgery also increases the risk of wound problems. This study compared outcomes among older adults with ankle fractures who received ORIF versus close contact casting.


This study was prospective, powered and randomised to determine the outcomes at 6 months of adults aged 60 years or older using the Olerund-Molander Ankle Score (OMAS). Patients were randomised to casting or surgery (ORIF) in a 1:1 ratio. The surgeons were trained in the casting technique before the study. If casting failed and the patient underwent ORIF, …

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  • Competing interests AY has institutional support in the form of a grant from ‘Acumed’ to study the outcomes of fibular nails and consult for the company on design. AY does not receive royalties or any other support related to ankle fracture treatment.

  • Provenance and peer review Commissioned; internally peer reviewed.