Large multi-center RCTs are worth celebrating with fireworks. The image is CC by Colin Knowles.

The Brits have done it again: an amazing, multi-center study on ankle surgery. They looked at 620 unstable ankle fractures and compared close contact casting (CCC) with surgery. Like so many orthopaedic interventions it seems that both methods are equivalent regarding patient reported outcome although 15% had malunion vs 3% in in the surgical group. Likewise there was a higher non-union in the CCC group, 10% vs 3%. Furthermore about 1 in 5 in the CCC group required later surgery. Continue reading →