Early Weightbearing and Range of Motion Versus Non-Weightbearing and Immobilization After Open Reduction and Internal Fixation of Unstable Ankle Fractures: A Randomized Controlled Trial

Dehghan, Niloofar; McKee, Michael D.; Jenkinson, Richard; Schemitsch, Emil H.; Stas, Venessa; Nauth, Aaron; Hall, Jeremy A.; Stephen, David; Kreder, Hans J.

doi:10.1097/bot.0000000000000572

Cited by 149 publications

(196 citation statements)

References 17 publications

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“…The participants in the study had stable, anatomically adequate fixation of the distal fibula and/or medial malleolus prior to being included in the trials. Recent studies on early weight-bearing of surgically treated fractures of the ankle joint showed good outcome and even a lower rate of plate removal (31,32). In one radiostereometric study with fractures of the tibial plateau, the mean cranio-caudal migration of the fracture fragments at 1 year after the start of early weight-bearing was insignificant -0.34 mm (-1.64 to 1.51) (33).…”

Section: Resultsmentioning

confidence: 99%

A protocol for permissive weight-bearing during allied health therapy in surgically treated fractures of the pelvis and lower extremities

Meys¹,

Kalmet²,

Sanduleanu³

et al. 2019

J Rehabil Med

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Aftercare in surgically treated trauma patients with fractures of the pelvis and lower extremities has remained largely unchanged during the past 60 years. To optimize rapid clinical recovery and the restoration of function and functionality, permissive weight-bearing has been designed as a new aftercare mobilization regime, within the upper boundary of the therapeutic bandwidth, yet safe enough to avoid overloading. The aim of the present paper is to describe a comprehensive protocol for permissive weight-bearing during allied health therapy and to report on both the time to full weight-bearing and the number of complications in patients with surgically treated fractures of the pelvis and lower extremities who undergo permissive weight-bearing. Objective: To optimize rapid clinical recovery and restoration of function and functionality, permissive weight-bearing has been designed as a new aftercare mobilization regimen, within the upper boundary of the therapeutic bandwidth, yet safe enough to avoid overloading. The aim of the present paper is to describe a comprehensive protocol for permissive weight-bearing during allied health therapy and to report on the time to full weight-bearing, as well as the number of complications, in patients with surgically treated fractures of the pelvis and lower extremities undergoing permissive weight-bearing. Patients and methods: This study included surgically treated trauma patients with (peri)-or intra-articular fractures of the pelvis and lower extremities. A standardized permissive weight-bearing protocol was used for all patients. Time to full weight-bearing and number of complications were recorded. Results: This study included 150 patients, 69% male, with a median age of 48 years (interquartile range (IQR) 33.0, 57.0). The median time to full weight bearing was 12.0 weeks (IQR 6.8, 19.2). The complication rate during rehabilitation was 10%. Conclusion: The permissive weight-bearing protocol, as described, might be beneficial and has potential to be implemented in trauma patients with surgically treated (peri)-or intra-articular fractures of the pelvis and lower extremities.

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Section: Resultsmentioning

confidence: 99%

A protocol for permissive weight-bearing during allied health therapy in surgically treated fractures of the pelvis and lower extremities

Meys¹,

Kalmet²,

Sanduleanu³

et al. 2019

J Rehabil Med

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“…Finally, other advantages (i.e., prevention of muscle wasting and osteoporosis) are expected. However, these effects have not been investigated thus far [11,12].…”

Section: Discussionmentioning

confidence: 99%

Is immediate weight bearing safe for lateral malleolus fracture after surgery?

Lee

Choi²,

Choi

et al. 2020

Preprint

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Introduction Lateral malleolus fracture is one of the most common fractures. However, there is controversy regarding the rehabilitation protocols used after surgery. In particular, the initiation point for weight bearing has not been standardized. In the present study, we investigated the prognostic difference between immediate and delayed weight bearing on lateral malleolus fractures. Materials and Methods The medical records of matched 50 and 41 patients in the immediate and delayed weight-bearing groups were reviewed retrospectively. All patients were treated with open reduction and internal fixation using an anatomical locking compression plate. In the immediate weight-bearing group (IWB), tolerable weight bearing (i.e., can be endured immediately after surgery with crutches) was permitted. In the delayed weight-bearing group (DWB), weight bearing was completely restricted for 4 weeks after surgery. Ankle motion exercise was permitted in both groups starting from the day after surgery. Radiographic assessment data and clinical outcomes were reviewed. Results No significant differences in the radiographic assessments and complications were found between the two groups. Significant differences in shortened length of hospital stay and time to return to work with the IWB rehabilitation protocol were confirmed (IWB group vs. DWB group: 5.7 vs. 8.0 days and 6.0 vs. 8.0 months, respectively). A significant difference in sport factor was observed in the Foot and Ankle Outcome Score at 3 months postoperatively (75.5 vs 68.5). Conclusions We found no significant differences between the two groups with respect to postoperative radiological outcome and complications. The benefits of shortening the time to return to work and length of hospital stay associated with the IWB rehabilitation protocol were confirmed. In conclusion, immediate weight bearing is recommended in patients with lateral malleolus fracture after anatomical reduction and firm fixation by surgery.

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“…For ankle fracture, early weight bearing after ORIF is feasible biomechanically without loss of reduction or fixation failure [28]. Dehghan et al [16] designed a multicenter RCT, 110 patients with an unstable ankle fracture underwent ORIF, they were randomly divided into two groups, in the early weightbearing group, patients started full weightbearing at 2…”

Section: Discussionmentioning

confidence: 99%

“…We retrospectively reviewed patients who were diagnosed as SER IV ankle fractures (AO/OTA classification 44-B3.1), they underwent surgical treatment between January 2012 and December 2015. The inclusion criteria were as follows: patients underwent ORIF with TEF or ORIF with DLR, pre-and postoperative X-rays evaluation, a preoperative magnetic resonance imaging (MRI) and three-dimensional computed tomography (CT), patients greater than 16 A total of 745 ankle fractures treated operatively were identified initially. 584 were excluded because of multiple and open fractures, 23 old fractures were also excluded, 78 were excluded because of no MRI examination, 17 were excluded because of loss of follow-up.…”

Section: Methodsmentioning

confidence: 99%

Transarticular external fixation versus deltoid ligament repair in treating SER IV ankle fractures: a comparative study

Wang

Zhang

et al. 2019

Preprint

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Background The topic that whether the injured deltoid ligament should be repaired when associated with ankle joint fractures is still discussed. The objective of this study was to compare the clinical effect of open reduction and internal fixation (ORIF) with deltoid ligament repair (DLR) or transarticular external fixation (TEF) in treating supination-external rotation type IV (SER IV) ankle fractures. Methods Between January 2012 and December 2015, 43 patients were diagnosed as SER IV ankle fractures, 20 underwent ORIF and transarticular external fixation (TEF) without DLR (group 1), 23 were treated with ORIF and DLR (group 2). The pre- and post-operative radiographic examination were performed, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the visual analog scale (VAS), the Medical Outcomes Short Form 36-item questionnaire score (SF-36), and the ankle range of motion (ROM) were used for functional evaluation. Results In both groups, the three scores improved significantly after surgery, but there was no significant difference between the two groups. At 6 weeks after surgery, patients in group 2 had better ankle ROM than group 1 (29.35 ± 2.033 vs. 40.35 ± 3.550, P < 0.001), but there was no difference at 12 months postoperatively. No cases of bone nonunion or post-traumatic arthritic changes were seen during the follow-up. Patients in group 1 required a shorter time to achieve fracture union than patients in group 2. Conclusions ORIF with TIF is an optional strategy to manage SER IV ankle fractures as it achieves comparable functional results to ORIF with DLR. It also allows patients to start relatively earlier weight-bearing and may promote fracture union. Keywords Transarticular external fixation; ORIF; Deltoid ligament repair; Supination-external rotation; Ankle fracture

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Early Weightbearing and Range of Motion Versus Non-Weightbearing and Immobilization After Open Reduction and Internal Fixation of Unstable Ankle Fractures: A Randomized Controlled Trial

Abstract: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Cited by 149 publications

References 17 publications

A protocol for permissive weight-bearing during allied health therapy in surgically treated fractures of the pelvis and lower extremities

A protocol for permissive weight-bearing during allied health therapy in surgically treated fractures of the pelvis and lower extremities

Is immediate weight bearing safe for lateral malleolus fracture after surgery?

Transarticular external fixation versus deltoid ligament repair in treating SER IV ankle fractures: a comparative study

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