How long should patients be kept non-weight bearing after ankle fracture fixation? A survey of OTA and AOFAS members

Swart, Eric; Bezhani, Hariklia; Greisberg, Justin; Vosseller, J. Turner

doi:10.1016/j.injury.2015.03.029

Cited by 67 publications

(45 citation statements)

References 12 publications

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“…In addition, several studies on different lower extremity fractures did not demonstrate negative effects of early weight-bearing [12,13,15]. However, factors such as comorbidities and injury pattern, influence the surgeon's choice of postoperative care regimen in an attempt to avoid complications [31]. With respect to the postoperative treatment of ankle fractures, multiple studies investigated either early weight-bearing or early mobilization (active ankle exercises), but not a combination [9,10,26,35].…”

Section: Discussionmentioning

confidence: 99%

“…For a good functional recovery and prevention of osteoarthritis, fractures with incongruency of the tibiotalar joint are treated operatively [19]. Subsequently, a wide variety of postoperative care regimens are used, ranging from immobilization in a cast without weight-bearing to immediate weight-bearing without a cast [11,31,35]. Various studies have shown good functional outcomes 1 year after surgery for the different postoperative protocols [9,26,35].…”

Section: Introductionmentioning

confidence: 99%

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Weight-bearing or non-weight-bearing after surgical treatment of ankle fractures: a multicenter randomized controlled trial

Smeeing

Houwert

Briët

et al. 2018

Eur J Trauma Emerg Surg

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Purpose The goal of this study was to assess if unprotected weight-bearing as tolerated is superior to protected weightbearing and unprotected non-weight-bearing in terms of functional outcome and complications after surgical fixation of Lauge-Hansen supination external rotation stage 2-4 ankle fractures. Methods A multicentered randomized controlled trial was conducted in patients ranging from 18 to 65 years of age without severe comorbidities. Patients were randomized to unprotected non-weight-bearing, protected weight-bearing, and unprotected weight-bearing as tolerated. The primary endpoint of the study was the Olerud Molander Ankle Score (OMAS) 12 weeks after randomization. The secondary endpoints were health-related quality of life using the SF-36v2, time to return to work, time to return to sports, and the number of complications. Results The trial was terminated early as advised by the Data and Safety Monitoring Board after interim analysis. A total of 115 patients were randomized. The O'Brien-Fleming threshold for statistical significance for this interim analysis was 0.008 at 12 weeks. The OMAS was higher in the unprotected weight-bearing group after 6 weeks c(61.2 ± 19.0) compared to the protected weight-bearing (51.8 ± 20.4) and unprotected non-weight-bearing groups (45.8 ± 22.4) (p = 0.011). All other follow-up time points did not show significant differences between the groups. Unprotected weight-bearing showed a significant earlier return to work (p = 0.028) and earlier return to sports (p = 0.005). There were no differences in the quality of life scores or number of complications. Conclusions Unprotected weight-bearing and mobilization as tolerated as postoperative care regimen improved short-term functional outcomes and led to earlier return to work and sports, yet did not result in an increase of complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Weight-bearing or non-weight-bearing after surgical treatment of ankle fractures: a multicenter randomized controlled trial

Smeeing

Houwert

Briët

et al. 2018

Eur J Trauma Emerg Surg

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“…One of the key objections to allowing early weight-bearing is the possibility of fracture displacement (19). On the other hand, various authors, including those of more recent randomized controlled trials, have stated that weightbearing does not pose an undue risk of complications or produce poorer outcomes than non-weight-bearing protocols (20). These 2 statements are contradictory and require further evaluation.…”

Section: Discussionmentioning

confidence: 99%

A protocol for permissive weight-bearing during allied health therapy in surgically treated fractures of the pelvis and lower extremities

Meys¹,

Kalmet²,

Sanduleanu³

et al. 2019

J Rehabil Med

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Aftercare in surgically treated trauma patients with fractures of the pelvis and lower extremities has remained largely unchanged during the past 60 years. To optimize rapid clinical recovery and the restoration of function and functionality, permissive weight-bearing has been designed as a new aftercare mobilization regime, within the upper boundary of the therapeutic bandwidth, yet safe enough to avoid overloading. The aim of the present paper is to describe a comprehensive protocol for permissive weight-bearing during allied health therapy and to report on both the time to full weight-bearing and the number of complications in patients with surgically treated fractures of the pelvis and lower extremities who undergo permissive weight-bearing. Objective: To optimize rapid clinical recovery and restoration of function and functionality, permissive weight-bearing has been designed as a new aftercare mobilization regimen, within the upper boundary of the therapeutic bandwidth, yet safe enough to avoid overloading. The aim of the present paper is to describe a comprehensive protocol for permissive weight-bearing during allied health therapy and to report on the time to full weight-bearing, as well as the number of complications, in patients with surgically treated fractures of the pelvis and lower extremities undergoing permissive weight-bearing. Patients and methods: This study included surgically treated trauma patients with (peri)-or intra-articular fractures of the pelvis and lower extremities. A standardized permissive weight-bearing protocol was used for all patients. Time to full weight-bearing and number of complications were recorded. Results: This study included 150 patients, 69% male, with a median age of 48 years (interquartile range (IQR) 33.0, 57.0). The median time to full weight bearing was 12.0 weeks (IQR 6.8, 19.2). The complication rate during rehabilitation was 10%. Conclusion: The permissive weight-bearing protocol, as described, might be beneficial and has potential to be implemented in trauma patients with surgically treated (peri)-or intra-articular fractures of the pelvis and lower extremities.

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“…As even a 3-mm step-off in the tibial plateau can increase the cartilage contact stresses by 75%, concerns are raised that loss of reduction could lead to worse patient outcomes, even in case of non-weight bearing [24]. On the other hand, it is often stated that early weight bearing does not pose an undue risk of complications or worse patient outcomes compared to a non-weight bearing protocol, as reported in a recent randomized controlled trial dealing with fractures of the ankle joint [25]. These two statements are contradictory and require further elaboration.…”

Section: Discussionmentioning

confidence: 99%

Patient-reported quality of life and pain after permissive weight bearing in surgically treated trauma patients with tibial plateau fractures: a retrospective cohort study

Kalmet

Horn

Sanduleanu

et al. 2018

Arch Orthop Trauma Surg

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IntroductionA Dutch survey among orthopedic surgeons and trauma surgeons showed that almost 90% of the surgeons do not follow protocols regarding the weight bearing aftercare for tibial plateau fractures. Clinical studies comparing permissive weight bearing (PWB) versus restricted weight bearing (RWB) after surgically treated tibial plateau fractures are not available. The aim of this study was to inventory potential differences in quality of life and pain, and number of complications in patients with surgically treated tibial plateau fractures who followed a PWB regime, relative to those that followed a RWB regime.Materials and methodsThis retrospective cohort study included surgically treated trauma patients with tibial plateau fractures, who underwent rehabilitation according to PWB or RWB between 2005 and 2015. Data such as demographics, patient-reported quality of life and pain, and patient outcome were collected.ResultsThis cohort study included 91 patients with a tibial plateau fracture (31 and 60 patients in the PWB and RWB groups respectively). No significant between-group differences in either age or gender were found. However, a significant difference in fracture type was found between groups, (p = 0.04). No significant differences were found in either patient-reported SF-12 or VAS scores between the PWB group and RWB group. Time to full weight bearing was significantly shorter in the PWB than in the RWB group, i.e., 14.7 versus 20.7 weeks, (p = 0.02). No significant differences were found regarding postoperative complications between the PWB and the RWB groups, i.e., 6.5% versus 10.0%, respectively.ConclusionPWB after surgically treated tibial plateau fractures is safe and is related to a significantly reduced time to full weight bearing with no significant differences in patient-reported quality of life and pain or complication rates.

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How long should patients be kept non-weight bearing after ankle fracture fixation? A survey of OTA and AOFAS members

Cited by 67 publications

References 12 publications

Weight-bearing or non-weight-bearing after surgical treatment of ankle fractures: a multicenter randomized controlled trial

Weight-bearing or non-weight-bearing after surgical treatment of ankle fractures: a multicenter randomized controlled trial

A protocol for permissive weight-bearing during allied health therapy in surgically treated fractures of the pelvis and lower extremities

Patient-reported quality of life and pain after permissive weight bearing in surgically treated trauma patients with tibial plateau fractures: a retrospective cohort study

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