Is early full weight bearing safe following locking plate ORIF of distal fibula fractures?

Abstract

Background In the modern western world appraisal of economical points such as treatment and disability after trauma present a financial burden. In this context open reduction internal fixation techniques allowing for early full weight bearing might not only improve the clinical outcome but also shorten the period of disability in working life. The aim of the study was to analyze whether ORIF of ankle fractures using either a standard semitubular plate or a new polyaxial locking plate system result in a better clinical outcome. Methods In this prospective study, all patients with distal fibula fractures (AO 44 B1.1, B1.2, B1.3), with indication for surgery were included. Patients were randomized to either the DePuy Synthes® one-third semitubular plate (Group I) or NEWCLIP TECHNICS, Active Ankle® polyaxial locking plate (Group II). Primary outcome parameter was function of the ankle joint, assessed by the Olerud and Molander ankle score, Foot and Ankle outcome score and Karlsson and Peterson Scoring System for Ankle function. Secondary outcome parameter were postoperative complications. Superficial wound infection, delayed wound healing, mechanically prominent implant, skin irritations were considered as minor and deep wound infection, material loosening, loss of reduction were regarded as major complications requiring revision surgery. Clinical and radiological follow-up were performed 6 and 12 weeks, 6 months and 1 year postoperatively. Results Fifty-two patients (31 W/21 M) with a mean age of 43 yrs. (range 22–64 yrs.) were enrolled. Seven patients (13.5%) were excluded, so that 45 patients were available for follow up. Twenty-five patients were treated with DePuy Synthes® one-third semitubular plate (55.6%; group I) while 20 patients received an anatomically preformed polyaxial locking plate (44.4%, group II). Four minor complications occurred in Group I (16%) compared to two minor complications in group II (10%). Significant better clinical results regarding OMAS (p < 0.02, < 0.04), KPSS (p < 0.04) and FAOS (p < 0.02, < 0.03) were observed 6 and 12 weeks after surgery in group II. Conclusions The results of the presented study demonstrate a significant better clinical functional outcome in the early postoperative follow-up in patients treated with a polyaxial locking plate. Furthermore, our data show that ORIF using polyaxial locking plates in combination with an early postoperative weight bearing presents a safe, stable treatment option for ankle fractures so that patients benefit especially in the early stages of recovery. Trial registration Registered 20 April 2020, retrospectively on ClinicalTrails.gov (NCT04370561).

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

“…Of the 8 studies comparing weight-bearing interventions, 3 reported better primary outcomes in the early weight-bearing group compared with the late weight-bearing groups, all of which measured outcomes over the short-term (2–12 weeks). 65,66,68 The other studies showed no differences or similar outcomes across groups. 22,62–64,67 Importantly, the 4 studies examining long-term outcomes of 6 or 12 months showed similar outcomes for both groups.…”

“…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.…”

“…Of the 8 studies comparing weight-bearing interventions, 2 compared immediate versus late weight-bearing 22,62 ; 4 compared early weight-bearing from 2 weeks, against late weight-bearing, starting at 6 weeks 63,[65][66][67] ; and 2 others compared 3 weeks (early) against 6 weeks (late). 64,68 A wide range of primary outcomes were used (Tables 3 and 4). Of the 8 studies comparing weightbearing interventions, 3 reported better primary outcomes in the early weight-bearing group compared with the late weight-bearing groups, all of which measured outcomes over the short-term (2-12 weeks).…”

“…28,29 However, an in-depth study of the feasibility and acceptability of biofeedback devices is needed if they are to be widely implemented. 76 Our narrative synthesis revealed that 3 studies reported better outcomes on their primary outcome in the early weightbearing group compared with the late weight-bearing group in the short-term (2-12 weeks), 65,66,68 but studies looking at long-term outcomes (6-12 months) did not report differences across groups. [62][63][64]67 By contrast, the 2021 systematic review and meta-analysis by Sernandez et al, 13 which included 20 randomized controlled trials looking at weight-bearing in ankle fractures after ORIF, reported no difference in outcomes between early and delayed weight-bearing.…”

A Prospective Randomized Study Comparing Functional Outcome in Distal Fibula Fractures between Conventional AO Semitubular Plating and Minimal Invasive Intramedullary “Photodynamic Bone Stabilisation”

“…Open reduction and internal fixation (ORIF) has become the standard of care for displaced ankle FX in adults [ 13 , 14 ]. Several techniques for internal ankle fixation are commonly used, ranging from simple lag screw fixation to plate osteosynthesis with non-locking to locking screw systems up to biodegradable systems [ 15 , 16 , 17 , 18 , 19 , 20 ]. In this context, several studies in the common literature focus on intramedullary (IM) fixation of the distal fibula FX, fracture stabilization, and the appearance of soft tissue-related complications in the older population [ 21 , 22 , 23 , 24 , 25 , 26 , 27 ].…”