Summary: For adults over 60 with an unstable acute ankle fracture, use of a molded below-knee cast with minimal padding (applied under anesthesia by a trained surgeon) may lead to the same functional outcomes for the ankle at 6 months as surgical internal fixation but with lower likelihood of infection and less operating room time. (However, casting may be associated with a higher rate of radiologic malunion than surgery).

https://www.ncbi.nlm.nih.gov/m/pubmed/27727383/

Strength of Recommendation = B

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