Journal
JOURNAL OF ORTHOPAEDIC TRAUMA
Volume 30, Issue 7, Pages 345-352Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/BOT.0000000000000572
Keywords
ankle fracture; weightbearing; weight bearing; weightbearing; ROM; mobilization; RCT; randomized controlled trial
Categories
Funding
- Sunnybrook Health Sciences Centre
- St. Michael's Hospital (Toronto, Canada) from Orthopaedic Trauma Association (OTA)
- Physicians Services Incorporation (PSI)
- Canadian Orthopaedic Trauma Society (COTS)
- Canadian Orthopaedic Association
- Orthopaedic Trauma Association Resident Research Grant
- Physician Services Inc Resident Research Grant
- Canadian Orthopaedic Trauma Society
- Stryker
- Zimmer-Biomet
- Acumed
- Canadian Institute of Health Research (CIHR)
- OTA
- PSI
- Depuy-Synthes
- Smith and Nephew
- Amgen
- Bioventus
- CIHR
- Johnson Johnson
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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.
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