Early full weight-bearing in patients with isolated displaced lateral malleolar fracture after rigid internal fixation with locking plates

Abstract

Background: The timing of post-operative full weight-bearing in patients of isolated displaced lateral malleolar fractures remains controversial. The aim of this study was to evaluate the outcomes of early full weight-bearing after rigid internal fixation of such fractures with locking plates. Methods: From 2012 to 2018, 46 patients who had closed isolated displaced lateral malleolar fractures were included in the study. All fractures were managed with open reduction and internal fixation with locking plates. The patients were allowed to walk bearing their full weight 2 weeks after the operation. The follow-up period was 41.5 months on average (range: 12-70 months). The patients were available to evaluate union conditions, functional results, and complications. Results: The fractures united smoothly with an average union time of 10.5 weeks (range: 8-16). At the final follow-up, the average American Orthopaedic Foot and Ankle Score Ankle-Hindfoot Score was 91 (range: 85-98). No complications were observed. Conclusion: For patients with isolated displaced lateral malleolar fractures, full weight-bearing is safe and effective, without an increase in the rate of complications, 2 weeks after open reduction and rigid fixation with locking plates.

Characteristics and Effectiveness of Postoperative Rehabilitation Strategies in Ankle Fractures: A Systematic Review

“…Of all studies, 40 23–61 described their postoperative rehabilitation strategy but did not evaluate effectiveness and 15 20–22,62–73 focused on evaluating the effectiveness of the postoperative rehabilitation strategy. This section reports only those 40 studies that described their postoperative rehabilitation strategy, focusing on weight-bearing, immobilization, and other therapy administered.…”

“…The studies categorized as early weight-bearing included an initial period of no weight-bearing, from 1 to 3 weeks, but most frequently 2 weeks, followed often by a period of partial weight-bearing from 2 to 6 weeks, before progressing to full weight-bearing (see Table, Supplemental Digital Content 3, http://links.lww.com/JOT/B766). [31][32][33][34][35][36][37][38][39][40][41]61 Progression to full weight-bearing was described inconsistently, with terms such as "gradual" without further clarification, 31,38 or not described at all. 37,41 In studies categorized as late weight-bearing, patients were advised to remain non-weight-bearing for up to at least 4 weeks, in most cases 6 weeks (see Table, Supplemental Digital Content 4, http://links.lww.com/JOT/B767).…”

“…[31][32][33][34][35][36][37][38][39][40][41]61 Progression to full weight-bearing was described inconsistently, with terms such as "gradual" without further clarification, 31,38 or not described at all. 37,41 In studies categorized as late weight-bearing, patients were advised to remain non-weight-bearing for up to at least 4 weeks, in most cases 6 weeks (see Table, Supplemental Digital Content 4, http://links.lww.com/JOT/B767). [42][43][44][45][46][47][49][50][51][52][53][54][55]58 Other studies advised patients to remain non-weightbearing for to 10-12 weeks.…”

“…Fourteen of 40 studies (35%) did not detail their postoperative rehabilitation therapy, other than a mention. 27,30,31,33,34,38,40,41,44,49,50,53,54,74 All of the remaining studies only provided limited details or a brief explanation of the number of sessions and type of exercises, which primarily targeted range of motion, 24,39,42,43,[46][47][48]51,56,[59][60][61] strength, 47 proprioception, 46,47 and the number or timing of sessions. 23,25,28,29,45,46,56,57,59,60 Other studies gave more details of their programs involving timing of exercises 55 and range of motion.…”