Effect of Early Weightbearing Following Open Reduction and Internal Fixation of Unstable Ankle Fractures on Wound Complications or Failures of Fixation

Abstract

Background: There is a growing trend toward early weightbearing as tolerated (WBAT) after open reduction and internal fixation (ORIF) of ankle fractures. To date, studies have excluded fractures with associated syndesmotic injuries from their cohorts. Methods: In this retrospective cohort study, a chart review was performed at a single level 1 trauma center, identifying all unstable ankle fractures that underwent operative fixation between July 2016 and July 2017. After exclusion criteria, 63 patients were identified and 31 were included in the final analysis, with 14 undergoing syndesmotic fixation. WBAT was initiated after suture removal, between 2 and 4 weeks postoperatively. Outcomes included fracture union, radiographic maintenance of alignment, hardware failures, wound complications, and the need for repeat surgery. Results: Weightbearing was initiated at an average of 17.8 days. All 31 patients progressed toward fracture union, with no hardware failures. Three patients developed superficial wound breakdown, which was treated with protected weightbearing in all cases and oral antibiotics in 1 case. All 3 went on to heal from their incisions. One patient had delayed wound breakdown and required a split-thickness skin graft that subsequently healed without complication. One patient underwent hardware removal 6 months postoperatively. There were no revision ORIF procedures. Conclusion: There is literature supporting early WBAT after ORIF of unstable ankle fractures in patients without major comorbidities. This article supports this trend, demonstrating that a group of ankle fractures requiring syndesmotic fixation were included in the early weightbearing cohort without a higher rate of catastrophic failure or increased wound problems. Level of Evidence Level IV, retrospective cohort study.

Risk Factors for Aseptic Revision of Operatively Treated Ankle Fractures

“…Furthermore, there were no differences noted in postoperative weightbearing restrictions or documented weightbearing compliance (Supplemental Table 2a-d). This tracks with a recent investigation by Pyle et al, 43 who found that early weightbearing (2-4 weeks postoperatively) after unstable ankle fracture ORIF with or without syndesmotic injury did not increase the risk of wound complications or failure of fixation among their cohort of 31 patients. Notably, surgeon fellowship training had no correlation with an increased need for revision.…”

Rehabilitation effect of standing bed combined with early anti-gravity running table training on ankle fracture

“…Foreign scholars proposed 12 , 13 that early weight bearing in postoperative ankle fracture patients can help accelerate fracture healing, and early postoperative weight bearing will not lead to problems such as loosening of internal fixation, and it is believed that early weight bearing training is advantageous for ankle joint function recovery and fracture healing. Some scholars have confirmed 14 that early weight-bearing is beneficial to fracture healing, shortens fracture healing time, and promotes the recovery of joint function.The results of this study showed that early standing bed participation in weight-bearing training, and anti-gravity running table training intervention for 8 weeks after the increase in bone mineral density, the quality of bone scab score is higher than that of the control group who received conventional treatment, and there is no displacement of the fracture broken end and the phenomenon of loosening of the internal fixation, which suggests that early progressive weight-bearing can help to accelerate the healing of the fracture, which may be related to the stress stimulation of the fracture broken end, which is in line with the previous research findings Consistent.…”

Holistic Approach via Physiotherapeutic Intervention in a Complex Multiple Fracture Hampering a Middle-Class Man’s Life- a Case Report

“…Immobilization, on the other hand, can be linked to a reduced range of motion, ankle stiffening, and muscular weakness [14]. Early mobility, on either hand, is thought to be critical for most fractures' healing, as well as minimizing joint stiffness and problems associated with extended immobilization, which may also help to speed up recovery and enhance overall function and quality of life [15]. Joint manipulation, gradual exercise performance, gait training plan, electrotherapy, and good health education have all been demonstrated to be useful in physiotherapy rehabilitation [16,17].…”