Niloofar Dehghan1, Michael D McKee, Richard J Jenkinson, Emil H Schemitsch, Venessa Stas, Aaron Nauth, Jeremy A Hall, David J Stephen, Hans J Kreder. 1. *Department of Orthopaedics, Li Ka Shing Institute, St. Michael's Hospital and the University of Toronto, Toronto, Canada; †Division of Orthopaedics, Department of Surgery, St. Michael's Hospital and the University of Toronto, Toronto, Canada; ‡Division of Orthopaedics, Department of Surgery, Sunnybrook Health Science Centre and the University of Toronto, Toronto, Canada; §Department of Surgery, Western University, London, Canada; ‖Department of Surgery, St. Vincent Medical Center, Portland, OR; ¶Division of Orthopaedics, Department of Surgery, Sunnybrook Health Science Centre and the University of Toronto, Toronto, Canada; and **Division of Orthopaedics, Department of Surgery, Sunnybrook Health Science Centre and the University of Toronto, Toronto, Canada.
Abstract
OBJECTIVES: The aim of this study was to compare early weightbearing and range of motion (ROM) to nonweightbearing and immobilization in a cast after surgical fixation of unstable ankle fractures. DESIGN: Multicentre randomized controlled trial. SETTING: Two-level one trauma centers. PATIENTS: One hundred ten patients who underwent open reduction and internal fixation of an unstable ankle fracture were recruited and randomized. INTERVENTION: One of 2 rehabilitation protocols: (1) Early weightbearing (weightbearing and ROM at 2 weeks, Early WB) or (2) Late weightbearing (nonweightbearing and cast immobilization for 6 weeks, Late WB). MAIN OUTCOME MEASUREMENTS: The primary outcome measure was time to return to work (RTW). Secondary outcome measures included: ankle ROM, SF-36 heath outcome scores, Olerud/Molander ankle function score, and rates of complications. RESULTS: There was no difference in RTW. At 6 weeks postoperatively, patients in the Early WB group had significantly improved ankle ROM (41 vs. 29, P < 0.0001); Olerud/Molander ankle function scores (45 vs. 32, P = 0.0007), and SF-36 scores on both the physical (51 vs. 42, P = 0.008) and mental (66 vs. 54, P = 0.0008) components. There were no differences with regard to wound complications or infections and no cases of fixation failure or loss of reduction. Patients in the Late WB group had higher rates of planned/performed hardware removal due to plate irritation (19% vs. 2%, P = 0.005). CONCLUSIONS: Given the convenience for the patient, early improved functional outcome, and the lack of an increased complication rate, we recommend early postoperative weightbearing and ROM in patients with surgically treated ankle fractures. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
RCT Entities:
OBJECTIVES: The aim of this study was to compare early weightbearing and range of motion (ROM) to nonweightbearing and immobilization in a cast after surgical fixation of unstable ankle fractures. DESIGN: Multicentre randomized controlled trial. SETTING: Two-level one trauma centers. PATIENTS: One hundred ten patients who underwent open reduction and internal fixation of an unstable ankle fracture were recruited and randomized. INTERVENTION: One of 2 rehabilitation protocols: (1) Early weightbearing (weightbearing and ROM at 2 weeks, Early WB) or (2) Late weightbearing (nonweightbearing and cast immobilization for 6 weeks, Late WB). MAIN OUTCOME MEASUREMENTS: The primary outcome measure was time to return to work (RTW). Secondary outcome measures included: ankle ROM, SF-36 heath outcome scores, Olerud/Molander ankle function score, and rates of complications. RESULTS: There was no difference in RTW. At 6 weeks postoperatively, patients in the Early WB group had significantly improved ankle ROM (41 vs. 29, P < 0.0001); Olerud/Molander ankle function scores (45 vs. 32, P = 0.0007), and SF-36 scores on both the physical (51 vs. 42, P = 0.008) and mental (66 vs. 54, P = 0.0008) components. There were no differences with regard to wound complications or infections and no cases of fixation failure or loss of reduction. Patients in the Late WB group had higher rates of planned/performed hardware removal due to plate irritation (19% vs. 2%, P = 0.005). CONCLUSIONS: Given the convenience for the patient, early improved functional outcome, and the lack of an increased complication rate, we recommend early postoperative weightbearing and ROM in patients with surgically treated ankle fractures. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Authors: Emilia Möller Rydberg; Jonas Skoglund; Hampus Brezicka; Jan Ekelund; Mikael Sundfeldt; Michael Möller; David Wennergren Journal: BMC Musculoskelet Disord Date: 2022-04-29 Impact factor: 2.562
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Authors: Lisa G M Friedman; Daniela Sanchez; Terri A Zachos; Andrew Marcantonio; Megan Audet; Heather Vallier; Brian Mullis; Adam Myers-White; Laurence Kempton; Jeffrey Watts; Daniel S Horwitz Journal: J Am Acad Orthop Surg Glob Res Rev Date: 2021-05-11
Authors: Rebecca Kearney; Rebecca McKeown; Helen Parsons; Aminul Haque; Nick Parsons; Henry Nwankwo; James Mason; Martin Underwood; Anthony C Redmond; Jaclyn Brown; Siobhan Kefford; Matthew Costa Journal: BMJ Date: 2021-07-05