K Rellensmann1, S F Baumbach1, W Böcker1, H Polzer2,3. 1. Sektion für Fuß- und Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Ludwig-Maximilians-Universität, Nußbaumstr. 20, 80336, München, Deutschland. 2. Sektion für Fuß- und Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Ludwig-Maximilians-Universität, Nußbaumstr. 20, 80336, München, Deutschland. Hans.Polzer@med.uni-muenchen.de. 3. Department of Orthopaedic Surgery, Columbia University Medical Center, New York, USA. Hans.Polzer@med.uni-muenchen.de.
Abstract
BACKGROUND: Ankle fractures are among the most common fractures in adults but often with unsatisfactory long-term results. In recent years several new surgical treatment approaches have been developed but little has changed regarding the aftercare. The postoperative treatment can be divided into two main components, weight bearing and mobilization. In Germany most patients are still recommended to be immobilized with partial weight bearing for 6 weeks after surgery. OBJECTIVE: The aim of this review is to present the current evidence on postoperative treatment based on an extensive literature search. MATERIAL AND METHODS: A total of seven prospective randomized controlled trials (RCT) compared early and delayed full weight bearing and six RCTs compared ankle mobilization with a form of immobilization. RESULTS: In none of these studies did early full weight bearing lead to an increased complication rate but some studies found a shortened time before return to work and, at least in the short term, better clinical results. Immediate mobilization led to an increased complication rate in only one out of six studies. It also appeared that mobilization led to a reduced time before return to work and, in the short term, to better clinical outcomes. The comparability of the studies was limited as in most cases different clinical scores and parameters were collated. In addition, information on patient age, fracture type, bone quality, comorbidities, and the implants used was often inadequate and post-treatment regimens sometimes differed significantly. CONCLUSION: The early functional therapy following surgically treated ankle fractures increased the rate of wound healing complications in only one of 13 studies, otherwise there were no significant differences in complication rates; however, early functional therapy partly shortened the time to return to work and led to better clinical results in the short term. For future studies, standardization of the parameters assessed would be important to provide clear evidence-based guidelines on follow-up treatment for specific fractures and patient populations.
BACKGROUND: Ankle fractures are among the most common fractures in adults but often with unsatisfactory long-term results. In recent years several new surgical treatment approaches have been developed but little has changed regarding the aftercare. The postoperative treatment can be divided into two main components, weight bearing and mobilization. In Germany most patients are still recommended to be immobilized with partial weight bearing for 6 weeks after surgery. OBJECTIVE: The aim of this review is to present the current evidence on postoperative treatment based on an extensive literature search. MATERIAL AND METHODS: A total of seven prospective randomized controlled trials (RCT) compared early and delayed full weight bearing and six RCTs compared ankle mobilization with a form of immobilization. RESULTS: In none of these studies did early full weight bearing lead to an increased complication rate but some studies found a shortened time before return to work and, at least in the short term, better clinical results. Immediate mobilization led to an increased complication rate in only one out of six studies. It also appeared that mobilization led to a reduced time before return to work and, in the short term, to better clinical outcomes. The comparability of the studies was limited as in most cases different clinical scores and parameters were collated. In addition, information on patient age, fracture type, bone quality, comorbidities, and the implants used was often inadequate and post-treatment regimens sometimes differed significantly. CONCLUSION: The early functional therapy following surgically treated ankle fractures increased the rate of wound healing complications in only one of 13 studies, otherwise there were no significant differences in complication rates; however, early functional therapy partly shortened the time to return to work and led to better clinical results in the short term. For future studies, standardization of the parameters assessed would be important to provide clear evidence-based guidelines on follow-up treatment for specific fractures and patient populations.
Authors: Philip J Belmont; Shaunette Davey; Nicholas Rensing; Julia O Bader; Brian R Waterman; Justin D Orr Journal: J Orthop Trauma Date: 2015-12 Impact factor: 2.512
Authors: B J Braun; N T Veith; S C Herath; R Hell; M Rollmann; M Orth; J H Holstein; T Pohlemann Journal: Unfallchirurg Date: 2018-04 Impact factor: 1.000