Close contact casting, ORIF for unstable ankle fractures equivalent at 6 months

SAN DIEGO — Treatment of unstable malleolar fractures with close contact casting showed equivalent outcomes to those of open reduction internal fixation among elderly patients, as well as a cost reduction, according to results of a multicenter study presented at the Orthopaedic Trauma Association Annual Meeting.

“Preferentially selecting a strategy of closed contact casting provided equivalent functional outcomes to open reduction internal fixation in all measures at 6 months with less resources used,” Keith Willett, FRCS, said. “A portion of patients with close contact casting will convert to surgery. It can be avoided in four out of five patients.”

Willett and colleagues randomly assigned 620 patients over the age of 60 years with unstable malleolar fractures to undergo either close contact casting or open reduction internal fixation (ORIF). The primary outcome measure the investigators used was the Olerud and Molander ankle score at 6 months after treatment.

Keith Willett

Willett noted 9% of patients in the open reduction internal fixation group underwent a second open surgery procedure for complications and 19% of patients in the close contact casting group were converted to open surgery.

Results showed close contact casting had equivalent functional outcomes to ORIF, which was also shown in the intention-to-treat analysis. However, no differences were found in secondary outcomes of mental and physical scores, quality of life, ankle range of motion, pain, mobility and patient satisfaction.

“The medium area of the nonunion rate was high in the close contact cast group, but that did not affect the mean treatment outcome, as we have seen. Neither did it affect the mobility Timed Up and Go test,” Willett said. “Neither did it affect any difference between any of the other secondary outcome measures between the two groups.”

There were some significant complications seen, Willet said, noting they were “six-times more common in the open reduction internal fixation group in this patient population … with 40% having comorbidities.”

As for the health economic evaluation the investigators performed, close contact casting was about $2,000 cheaper per patient compared with ORIF, he said. – by Casey Tingle

Reference:

Willett K, et al. Paper #31. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 7-10, 2015; San Diego.

Disclosure: Willett receives royalties from Zimmer.