According to a new study involving 620 patients at 24 UK hospitals, elderly patients with unstable ankle fractures could possibly avoid surgery. The team, led by researchers at Oxford University, compared surgery to pin a broken ankle with a new plaster cast technique known as ‘close contact casting, ‘ The study was published in the October 2016 issue of the Journal of the American Medical Association.
Professor Keith Willett, FRCS(C) of the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences at the University of Oxford, and the Kadoorie Centre for Critical Care Research and Education at Oxford University Hospitals NHS [National Health Services] Foundation Trust, said in the October 11, 2016 news release, “Older adults—those over 60—are suffering an increasing number of ankle fractures from leading more active lifestyles and the rising prevalence of osteoporosis. However, we know that older patients have disproportionately poor outcomes, and their quality of life can suffer as they lose mobility.”
Commenting on traditional treatments for unstable fractures, Professor Willett said, “Each technique has drawbacks. Traditional plaster casts are associated with misaligned bones, poor healing and plaster sores. Surgery, especially in older people, is often complicated by poor implant fixation, wound healing problems and infection. However, a Cochrane review—considered a gold standard assessment of evidence for or against a medical technique or treatment—could not recommend preferring either treatment, as studies comparing them were of low quality.”
As indicated in the news release, “…Surgery led to more adverse events, with 116 reported, compared with 71 for the close contact cast group…”
Professor Willett told OTW, “I had previously learnt the long established skill of ‘total contact cast’ application to treat diabetic ulcers of the lower leg and foot. I explored the feasibility of employing that technique in a modified manner to my elderly ankle fracture patients with frail skin and found encouraging results. That led to a pilot study and then full trial.
“The contemporary default of recommending older patients with unstable ankle fractures to undergo open surgical fixation is now challenged and initially pursuing a non-surgical treatment is appropriate and for the majority, will be maintained, and produce equivalent patient reported outcomes for activity, pain, quality of life—i.e., there is now an alternative treatment that will avoid surgery in most older people, many of whom prefer to avoid surgery and its risks. It also uses less healthcare resources.
“Not only does it create an alternative orthopaedic approach to this injury, it challenges the orthodoxy that exact anatomical reconstruction is necessary for articular fractures.
“I certainly think from my initial experience and the study results, we should take a fresh look at the opportunities of non-surgical treatment in our increasingly comorbid and frail population.”
