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Early weight-bearing after ankle fracture fixation: a prospective randomized and non-blinded, outcome study
Abstract
Background: In early 2006 during AO-scholarship training at Hadassah Hospital in Jerusalem, I witnessed patients being walked on the same day after fixation of ankle fractures. This was contrary to my original teaching of protected non-weight bearing for six weeks. Literature review in this subject was inconclusive. I then determined to study and compare the functional benefit of early weight-bearing as compared to non- weight-bearing in these patients.
Design: Prospective, randomized non-blinded, outcome study.
Objective: To compare the functional outcome of early weight-bearing in patients with ankle fracture after open reduction and internal fixation.
Methods: Between June 2006 and June 2012 we randomized prospectively 70 consecutive patients who had open reduction and internal fixation for similar fractures of the ankle into two groups. All patients had below-knee cast applied post-operatively. Group 1 (study group) were allowed immediate partial weight-bearing with crutches while group 2 (control group) were mobilised non-weight-bearing with crutches for six weeks. All the patients were seen at 2, 6, 12 and 25 weeks. After six months (around the 25th week) we used a modified form of the American Academy of Orthopaedic Surgeons (AAOS) foot and ankle scale to evaluate the patients.
Results: We had a total of 62 patients by the end of the study, 30 in group 1 (mean age 41 years) and 32 in group 2 (mean age 41 years). Those in group 1 had higher functional scores at the last follow-up (75.1% vs. 55%, P < 0.001) which is highly significant. There was no sepsis in the study or control group. There was no loss of fixation in either group.
Conclusion: Our findings support the use of early protected weight-bearing after surgery for fractures of the ankle.
EAOJ; Vol. 7: September 2013
Design: Prospective, randomized non-blinded, outcome study.
Objective: To compare the functional outcome of early weight-bearing in patients with ankle fracture after open reduction and internal fixation.
Methods: Between June 2006 and June 2012 we randomized prospectively 70 consecutive patients who had open reduction and internal fixation for similar fractures of the ankle into two groups. All patients had below-knee cast applied post-operatively. Group 1 (study group) were allowed immediate partial weight-bearing with crutches while group 2 (control group) were mobilised non-weight-bearing with crutches for six weeks. All the patients were seen at 2, 6, 12 and 25 weeks. After six months (around the 25th week) we used a modified form of the American Academy of Orthopaedic Surgeons (AAOS) foot and ankle scale to evaluate the patients.
Results: We had a total of 62 patients by the end of the study, 30 in group 1 (mean age 41 years) and 32 in group 2 (mean age 41 years). Those in group 1 had higher functional scores at the last follow-up (75.1% vs. 55%, P < 0.001) which is highly significant. There was no sepsis in the study or control group. There was no loss of fixation in either group.
Conclusion: Our findings support the use of early protected weight-bearing after surgery for fractures of the ankle.
EAOJ; Vol. 7: September 2013
