ankle fracture

^[1]^[2]^[3]^[4]

Introduction

surgical repair
immobilization (orthopedic cast)
- close contact casting (molded, below-knee cast) as effective as internal fixation surgery in older adults (> 60 years) with acute, unstable ankle fracture^[2]
- 3 weeks casting for stable fibular fractures non-inferior to 6 weeks^[4]
- 3 year outcomes simlilar for casting vs surgery in older adults^[3]
rehabilitation after immobilization may not be of benefit^[1]

↑ ^1.0 ^1.1 Moseley AM Rehabilitation After Immobilization for Ankle Fracture. The EXACT Randomized Clinical Trial. JAMA. 2015;314(13):1376-1385. http://jama.jamanetwork.com/article.aspx?articleid=2449186
↑ ^2.0 ^2.1 Willett K, Keene DJ, Mistry D et al Close Contact Casting vs Surgery for Initial Treatment of Unstable Ankle Fractures in Older AdultsA Randomized Clinical Trial. JAMA. 2016;316(14):1455-1463 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27727383 <Internet> http://jamanetwork.com/journals/jama/article-abstract/2565749
Sanders DW Close Contact Casting vs Surgery for Unstable Ankle Fractures. JAMA. 2016;316(14):1451-1452 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27727370 <Internet> http://jamanetwork.com/journals/jama/article-abstract/2565734
↑ ^3.0 ^3.1 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 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29584832 https://jamanetwork.com/journals/jama/article-abstract/2676097
↑ ^4.0 ^4.1 Kortekangas T, Haapasalo H, Flinkkila T et al Three week versus six week immobilisation for stable Weber B type ankle fractures: randomised, multicentre, non-inferiority clinical trial. BMJ 2019;364:k5432. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30674451 https://www.bmj.com/content/364/bmj.k5432