Three-year follow-up of a trial of close contact casting vs surgery for initial treatment of unstable ankle fractures in older adults

A randomized clinical trial of close contact casting versus the usual practice of surgery for treating unstable ankle fractures in older adults found equivalent ankle function outcomes at 6 months.1 Higher rates of radiological ankle malunion in the casting vs surgical groups (15% vs 3%) and non-union (medial malleolus 7% vs 1%) suggested that equivalence between the two groups may be lost if symptoms or functional limitations from posttraumatic arthritis manifest later.2 A follow-up at least 3 years after randomization was conducted to determine if equivalence persisted over time