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In a previous study, researchers in the U.K. compared the functional outcomes of unstable ankle fractures in older adults (mean age, 71) treated with close contact casting vs. surgical fixation, with no difference at 6 months of follow-up (JAMA 2016; 316:1455). Because of a somewhat higher rate of nonunion or malunion in the casting group that could lead to longer-term problems, the researchers assessed functional outcome at 3 years. A total of 620 patients were randomized in the initial study, and 450 responded to follow-up. Roughly 8% to 10% of both groups had subsequent surgeries after 6 months.
At 3 years, no difference in functional outcomes or pain was noted between the two groups. In a subset of 67 patients that experienced healing ab…