Weight-Bearing and Mobilization in the Postoperative Care of Ankle Fractures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Cohort Studies

Abstract

PurposeTo determine the effectiveness and safety of interventions used for rehabilitation after open reduction and internal fixation of ankle fractures.MethodsA systematic review and meta-analysis was performed using both randomized trials and cohort studies. The effect of mobilization, weight-bearing, and unprotected weight-bearing as tolerated on postoperative recovery was compared using the Olerud Molander score, return to work/daily activities, and the rate of complications.ResultsA total of 25 articles were included. Ankle exercises resulted in earlier return to work and/or daily activities compared to immobilization (mean difference (MD) -20.76 days; 95% confidence interval (CI) -40.02 to -1.50). There was no difference in the rate of complications between exercises and immobilization (risk ratio (RR) 1.22; 95% CI 0.60 to 2.45) or between early and late weight-bearing (RR 1.26; 95%CI 0.56 to 2.85).InterpretationResults of this meta-analysis show that following ankle surgery, 1) active exercises accelerate return to work and daily activities compared to immobilization, 2) early weight-bearing tends to accelerate return to work and daily activities compared to late weight-bearing. Active exercises in combination with immediate weight-bearing may be a safe option.

Gait analysis related to functional outcome in patients operated for ankle fractures

“…Ankle fractures are among the most common lower limb fractures and account for 9% of all fractures . There are various classification systems to describe ankle fractures, for example, the AO‐classification, the Lauge–Hanssen classification, and the number of fractured malleoli .…”

Safety of Early Weight Bearing Following Fixation of Bimalleolar Ankle Fractures

“…Although a few studies have compared EWB and LWB for surgically stabilized ankle fractures and demonstrated similar functional outcomes, postoperative rehabilitation protocols have largely remained unchanged in today's clinical practice [4,8,11,[19][20][21][22][23][24][25]. Perhaps this relates to a lack of thorough investigation with regards to radiographic parameters other than fracture union when comparing EWB and LWB groups.…”

“…The incidence of ankle fractures is approximately 71-187 per 100,000 people per year and is one of the most common injuries treated by orthopedic surgeons [1][2][3][4][5]. The incidence is likely to increase as the average age of the population rises, as does the amount of participation in sports-related activities [6,7].…”

“…The purpose of this study is to better understand the advantages and disadvantages of EWB following ORIF of bimalleolar ankle fractures. This study provides a review of outcomes associated with a more aggressive postoperative protocol following bimalleolar ankle fracture fixation where patients are allowed to weight bear at three weeks postoperatively [4,8,11,[19][20][21][22][23][24][25]. We hypothesized that EWB following bimalleolar ankle fracture fixation would not negatively affect postoperative radiographic alignment, union rates, or rates of complication which included nonunion, malunion, and hardware failure.…”

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

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