BACKGROUND: It is commonly believed that early motion after joint fixation is advantageous, especially in the upper limb. In the ankle joint this is much less clear. No previous systematic review of the evidence for this could be found in the literature. MATERIALS AND METHODS: Nine randomized control trials were identified which met the inclusion criteria and compared early motion of the ankle joint to immobilization in a cast for 6 weeks. These varied in quality and numbers. All treated patients equally in all other respects including weight bearing. Where outcome measures were similar, some data pooling was possible. RESULTS: There is good evidence that early motion is associated with a quicker return to work on average (p = 0.008) and also with an improved range of motion at 12 weeks (dorsiflexion p = 0.001; plantarflexion p < 0.00001) compared to cast immobilization. However it is also associated with an increased risk of wound infection (p = 0.002). There is a suggestion that early motion results in a lower rate of deep vein thrombosis (p = 0.12). There is no evidence that it results in improved joint specific outcome scores or range of motion at 1 year. CONCLUSION: It is difficult to conclude whether early motion is overall better or worse than cast immobilization. The evidence suggests however that a young fit patient who needs to return to work may benefit from early motion of the ankle joint whereas a patient with poor skin or at risk of infection may be better treated in a cast after surgery.
BACKGROUND: It is commonly believed that early motion after joint fixation is advantageous, especially in the upper limb. In the ankle joint this is much less clear. No previous systematic review of the evidence for this could be found in the literature. MATERIALS AND METHODS: Nine randomized control trials were identified which met the inclusion criteria and compared early motion of the ankle joint to immobilization in a cast for 6 weeks. These varied in quality and numbers. All treated patients equally in all other respects including weight bearing. Where outcome measures were similar, some data pooling was possible. RESULTS: There is good evidence that early motion is associated with a quicker return to work on average (p = 0.008) and also with an improved range of motion at 12 weeks (dorsiflexion p = 0.001; plantarflexion p < 0.00001) compared to cast immobilization. However it is also associated with an increased risk of wound infection (p = 0.002). There is a suggestion that early motion results in a lower rate of deep vein thrombosis (p = 0.12). There is no evidence that it results in improved joint specific outcome scores or range of motion at 1 year. CONCLUSION: It is difficult to conclude whether early motion is overall better or worse than cast immobilization. The evidence suggests however that a young fit patient who needs to return to work may benefit from early motion of the ankle joint whereas a patient with poor skin or at risk of infection may be better treated in a cast after surgery.
Authors: S Aloraibi; J Gladman; D Godfrey; V Booth; K Robinson; E Lunt; A Caswell; M Kerr; B Ollivere; A L Gordon Journal: BMC Geriatr Date: 2021-05-24 Impact factor: 3.921
Authors: E M Van Schie-Van der Weert; E M M Van Lieshout; M R De Vries; M Van der Elst; T Schepers Journal: Arch Orthop Trauma Surg Date: 2011-09-30 Impact factor: 3.067
Authors: Jan Paul Briet; Roderick M Houwert; Diederik P J Smeeing; Janity S Pawiroredjo; Johannes C Kelder; Koen W Lansink; Luke P H Leenen; Peer van der Zwaal; Stephan W A M van Zutphen; Jochem M Hoogendoorn; Mark van Heijl; Egbert J M M Verleisdonk; Guus W van Lammeren; Michiel J Segers; Falco Hietbrink Journal: Trials Date: 2015-04-18 Impact factor: 2.279
Authors: Saleh Aloraibi; Vicky Booth; Katie Robinson; Eleanor Katharine Lunt; Deborah Godfrey; Alan Caswell; Margaret Kerr; Benjamin Ollivere; Adam Lee Gordon; J R F Gladman Journal: Age Ageing Date: 2021-06-28 Impact factor: 10.668