The release notes that casting instead of surgery as an initial treatment would result in “reduced intervention costs” but that’s not very helpful if you’re unsure of the base cost of surgery. Estimates of a cost differential would have been helpful. Close contact casting would be much cheaper than open surgery for these fractures. The release includes a list of benefits of the modified casting method, with some quantification, mostly in terms of reduced complications. It says, “At 6 months, casting resulted in measures of ankle function equivalent to that with surgery. Infection and wound breakdown were more common with surgery (10 percent vs 1 percent), as were additional operating room procedures (6 percent vs 1 percent).” A release devotes a fair amount of space to harms from casting as compared with surgery: “Radiologic malunion (abnormal healing of a fracture) was more common in the casting group (15 percent vs 3 percent for surgery). Casting required less operating room time compared with surgery. There were no significant differences in other secondary outcomes: quality of life, pain, ankle motion, mobility, and patient satisfaction.” This large randomized study with high rates of completion suggests a high quality of evidence, all noted in the news release. The release would have been better if it had noted that the outcome was blinded, a very important marker of quality as it is likely to reduce the risk of bias. No signs of disease mongering. These fractures are actually quite common, especially in the elderly, so it would have been appropriate to discuss the high disease burden from these fractures. No funding sources and conflicts are mentioned in the news release. Instead, readers are referred to the published study for details on “financial disclosures, funding and support.” However, the study is only available to JAMA subscribers. The release aptly compares this new treatment with traditional surgery, which has largely been abandoned due to high rates of malunion resulting in functional deficits in displaced ankle fractures. The release also briefly mentions traditional “hard” casting. The release quotes an accompanying editorial stating that “close contact casting may be unfamiliar to some orthopedic surgeons.” Although that’s a vague statement, we can assume it’s not in widespread use. In the U.S., most orthopedists are not trained in close contact casting nor do they feel comfortable using it. Most patients will not be offered this treatment as an option for their fracture care. This treatment is not novel, but the results of this study are new. It appears to be the first to compare these treatments and show the results in a well done randomized study. The release does not rely on sensational or exaggerated language.
Modified cast instead of surgery results in similar functional outcomes for ankle fracture in older adults