From the Drawer to the Journal: Hannu Lehtonen’s Ankle Fracture RCT Finally Published

We are thrilled to announce the publication of a long-awaited randomized trial led by Hannu Lehtonen: "Is 2-Week Cast Wearing Followed by 4-Week Functional Bracing Non inferior to 6-Week Cast Immobilization After Operative Fixation of an Ankle Fracture?" The study was just published in Clinical Orthopaedics and Related Research, one of the most prestigious orthopaedic trauma journals.

The trial tackled a familiar clinical dilemma: what is the optimal postoperative immobilization strategy following surgical fixation of ankle fractures? Patients were randomized after 2 weeks of cast immobilization to either continue casting or switch to functional bracing (Aircast). The findings? Functional outcomes were similar between groups, and no increased risk of wound complications was observed in the bracing group—a problem that plagued earlier efforts to skip casting altogether. These results support amore pragmatic, staged approach to postoperative care.

But this study has another story worth telling—the backstory of its principal investigator, Hannu Lehtonen. Hannu began his research journey in the late 1990s, but like many academic projects, his PhD work was eventually shelved due to life’s inevitable twists and turns.Our paths crossed again in 2023, and we made a pact to bring this unfinished work back to life.

In fact, this study was born out of an earlier trial published by Hannu back in 2003:

That earlier RCT compared casting versus functional bracing after ankle fracture surgery. While functional outcomes were comparable, the bracing group saw an alarming number of wound infections. As a response, the current trial was designed to implement functional bracing only after the surgical wounds had safely healed (i.e., after 2 weeks of casting).

Hannu personally recruited nearly all the patients and conducted the follow-ups himself. Then, as sometimes happens, the data ended up buried in a drawer—for years. To help rescue the project, we brought together a new team: Ville Ponkilainen (a rising orthopaedic talent from Tampere), and two of FICEBO’s trusted core members, Thomas Ibounig and Lasse Rämö. From the original group, Heikki Mäenpää—who had helped recruit patients—was still onboard alongside Hannu and myself.

It’s hard to describe the satisfaction of seeing this nearly-lost project finally published. Huge congratulations toHannu for his perseverance and scientific rigor, and to the entire team who made sure that good data didn’t go to waste.

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