This news release reports on the results of a randomized trial of older adults (average age 71) who had ankle fractures that were either treated with “close contact casting” or with surgery. While the outcomes after six months were similar in both groups the close contact casting was superior in terms of reduced infections and additional operating room procedures as well as being a lot safer. Yet many patients who received casting as an an initial treatment subsequently required repeat casting or surgery.
The release covers most of the bases and reported fairly on the essentials of the study, while not exaggerating either the benefits or risks of the surgical option. Readers might benefit from a definition of a ‘stable’ versus an ‘unstable’ ankle fracture and of “radiologic malunion.” The term sounds threatening but does not necessarily result in pain or functional impairment.
Ankle fractures are extremely common, and perhaps more common in older people so if one type of lower-tech procedure (close casting) can be proven to be safer, equally effective and less costly than the current standard of care (surgery) this could be a major plus to the healthcare systems around the world. Even though some of the patients in the study (about 20%) who received the casting option first had to go on to have a surgical intervention or a recasting, this study reinforces the view that surgery should be the second resort in most cases. Proof that a simpler closed intervention works well and should be tried first for these fractures stands to change the treatment of this common fracture.
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.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
Comments
Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.
Our Comments Policy
But before leaving a comment, please review these notes about our policy.
You are responsible for any comments you leave on this site.
This site is primarily a forum for discussion about the quality (or lack thereof) in journalism or other media messages (advertising, marketing, public relations, medical journals, etc.) It is not intended to be a forum for definitive discussions about medicine or science.
We will delete comments that include personal attacks, unfounded allegations, unverified claims, product pitches, profanity or any from anyone who does not list a full name and a functioning email address. We will also end any thread of repetitive comments. We don”t give medical advice so we won”t respond to questions asking for it.
We don”t have sufficient staffing to contact each commenter who left such a message. If you have a question about why your comment was edited or removed, you can email us at feedback@healthnewsreview.org.
There has been a recent burst of attention to troubles with many comments left on science and science news/communication websites. Read “Online science comments: trolls, trash and treasure.”
The authors of the Retraction Watch comments policy urge commenters:
We”re also concerned about anonymous comments. We ask that all commenters leave their full name and provide an actual email address in case we feel we need to contact them. We may delete any comment left by someone who does not leave their name and a legitimate email address.
And, as noted, product pitches of any sort – pushing treatments, tests, products, procedures, physicians, medical centers, books, websites – are likely to be deleted. We don”t accept advertising on this site and are not going to give it away free.
The ability to leave comments expires after a certain period of time. So you may find that you’re unable to leave a comment on an article that is more than a few months old.
You might also like