Early Ankle Movement Versus Immobilization in the Postoperative Management of Ankle Fracture in Adults: A Systematic Review and Meta-analysis

Abstract

T he incidence of ankle fracture is 71 per 100 000 person-years. There are age and sex differences, with peak incidence in younger men (between 15 and 29 years of age), whereas in women the incidence peaks at over 50 years of age. 38 Ankle fracture is caused by injury during physical activity and sport, and, in older people, osteoporosis is an important contributor. 19 Projections from Scandinavia suggest that the number of ankle fractures will increase 3-fold between 2006 and 2030, driven by the aging population 18 and increased participation of older people in sporting activities.1 Displaced and/or unstable ankle fractures often require surgery to restore and maintain congruence of ankle mortise. 15 The recommended surgical technique in developed countries over the last few decades has been open reduction and internal fixation. T T OBJECTIVES:To compare early ankle movement versus ankle immobilization after surgery for ankle fracture on clinical and patient-reported outcomes. T T BACKGROUND:A significant proportion of patients undergoing surgery for ankle fracture experience postoperative complications and delayed return to function. The risks and benefits of movement of the ankle in the first 6 weeks after surgery are not known, and clinical practice varies widely. T T METHODS:We searched bibliographic databases and reference lists to identify eligible trials. Two independent reviewers conducted data extraction and risk-of-bias assessments. T T RESULTS: Fourteen trials (705 participants)were included in the review, 11 of which were included in the meta-analysis. The quality of the trials was universally poor. The pooled effect of early ankle movement on function at 9 to 12 weeks after surgery compared to immobilization was inconclusive (standardized mean difference, 0.46; 95% confidence interval: -0.02, 0.93; P = .06; I 2 = 72%), and no differences were observed between groups at 1 year. The odds of venous thromboembolism were significantly lower with early ankle movement compared to immobilization (Peto odds ratio = 0.12; 95% confidence interval: 0.02, 0.71; P = .02; I 2 = 0%). Deep surgical site infection (Peto odds ratio = 7.08; 95% confidence interval: 1.39, 35.99; P = .02; I 2 = 0%), superficial surgical site infection, fixation failure, and reoperation to remove metalwork were more common after early ankle movement compared to immobilization. T T CONCLUSION:The quality of evidence is poor. The effects of early movement after ankle surgery on short-term functional outcomes are unclear, but there is no observable difference in the longer term. There is a small reduction in risk of postoperative thromboembolism with early ankle movement. Current evidence suggests that deep and superficial surgical site infections, fixation failure, and the need to remove metalwork are more common after early ankle movement. T T LEVEL OF EVIDENCE:Therapy, level 1a-. Ther 2014;44(9):690-701. Epub 6 August 2014. doi:10.2519/jospt.2014 Complete immobilization of the ankle by restraining ankle movement in a neutral position c...

The effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture

“…[8] Hence, that is why the endpoint of the present study is limited to the 3rd month after surgery. In reality, some studies [16–18] previously reported have supported the point of view that early exercise or mobilization can reduce the risk of developing lower limb DVT after an operation. And early mobilization in patients with acute deep vein thrombosis does not increase the risk of a symptomatic pulmonary embolism.…”

The Ankle Injury Management (AIM) trial: a pragmatic, multicentre, equivalence randomised controlled trial and economic evaluation comparing close contact casting with open surgical reduction and internal fixation in the treatment of unstable ankle fractures in patients aged over 60 years

“…The OMAS is one of the most commonly used outcome measures in ankle fracture research, 23,110 but has been criticised for methodological shortcomings in its development. 111 We found no published minimal clinically important differences for the OMAS and, therefore, had to develop the sample size drawing on wider literature and in consultation with clinical experts.…”

Structural and physical-functional deficits in lower limbs with fractures and treated surgically

“…After a fracture of the lower extremity, the period of immobility of the affected limb and the time of hospitalization of these patients may be factors capable of negatively influencing the body composition and the physical-functional aspects of the patients. Due to the need for postoperative medical follow-up and long periods of bed restriction in the hospital phase, it can cause muscular and bone hypotrophy, ligament and capsular retraction, joint stiffness and circulatory changes [17,18]. Even after years of hospital discharge, the patient may present negative physical-functional consequences, since there may be a delay in joining a rehabilitation program due to the difficulty of access to the public health system or the lack of effectiveness of the treatment [19,20].…”