In this issue of JAMA, Willett and colleagues1 tested the hypothesis that some patients with ankle fractures can be treated by casting alone without the need for operative stabilization and fixation of the fracture. The authors randomly assigned 620 patients aged older than 60 years with unstable ankle fractures at 24 hospitals in the United Kingdom to undergo surgical treatment or to receive close contact casting, consisting of a molded below-knee cast with minimal padding, applied in the operating room under anesthesia by a trained surgeon.