Safety of Early Weight Bearing Following Fixation of Bimalleolar Ankle Fractures

Passias, Braden J; Korpi, Frederick P.; Chu, Anson K.; Myers, Devon; Grenier, Greg; Galos, David K.; Taylor, Benjamin C.

doi:10.7759/cureus.7557

Cited by 12 publications

(21 citation statements)

References 27 publications

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“…24,33 NWB for 6 weeks has been considered the standard approach, as it is recognized that it takes approximately 6 weeks to achieve sufficient fracture healing that can resist the strain caused by weightbearing. 21,29,35 The theoretical risks of displacement of fixed fractures, implant failure, and loss of reduction have been deterring surgeons from permitting EWB. 29,35 However, in a biomechanical analysis of 24 fresh-frozen cadaveric models of EWB after ORIF of unstable ankle fractures, no relevant fracture displacement, hardware failure, or new fractures occurred after axial compression loading at a rate of 3 Hz from 0 to 1000 N for 250,000 cycles, which simulated 5 weeks of full weightbearing.…”

Section: Discussionmentioning

confidence: 99%

“…21,29,35 The theoretical risks of displacement of fixed fractures, implant failure, and loss of reduction have been deterring surgeons from permitting EWB. 29,35 However, in a biomechanical analysis of 24 fresh-frozen cadaveric models of EWB after ORIF of unstable ankle fractures, no relevant fracture displacement, hardware failure, or new fractures occurred after axial compression loading at a rate of 3 Hz from 0 to 1000 N for 250,000 cycles, which simulated 5 weeks of full weightbearing. 38 Possibly, fixation failure might be caused not by repeated loads of body weight but by a sudden, uncontrolled high load or a rotation force imposed on the ankle, as in unexpected falls.…”

Section: Discussionmentioning

confidence: 99%

“…internal fixation (ORIF) of fractures, nonweightbearing (NWB) for 6 weeks with active range of motion exercise in a removable cast or brace has been considered the standard approach traditionally. 17,29,35,37 A period of approximately 6 weeks is recognized as needed to achieve sufficient fracture healing that can resist the strain caused by weightbearing. 21 The theoretical risks of displacement of fixed fractures, implant failure, and loss of reduction have been deterring surgeons from permitting early weightbearing (EWB).…”

mentioning

confidence: 99%

“…21 The theoretical risks of displacement of fixed fractures, implant failure, and loss of reduction have been deterring surgeons from permitting early weightbearing (EWB). 29,35,37 However, several studies have reported that EWB started at 2 weeks postoperatively is safe; decreases ankle stiffness, muscle atrophy, and bone atrophy; and aids in early return to activities. 7,18,19,33,39,40,47 If EWB is not worse than NWB in terms of clinical outcomes and fixation stability, it may have secondary advantages over NWB, such as an earlier return to preinjury activities and the patients' satisfaction about being allowed to walk early.…”

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confidence: 99%

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Early Weightbearing Versus Nonweightbearing After Operative Treatment of an Ankle Fracture: A Multicenter, Noninferiority, Randomized Controlled Trial

Park

Kim

et al. 2021

Am J Sports Med

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Background: Acute ankle fractures can occur during sports activities, and unstable ankle fractures are commonly treated operatively. However, controversy exists about the optimal time to allow weightbearing. Hypothesis: Early weightbearing after the stable fixation of an ankle fracture is not inferior to nonweightbearing in terms of ankle function assessed at 12 months after injury. Study design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 258 patients were assessed for eligibility. Of these patients, 194 were randomly allocated to either the early weightbearing group (95 patients who were allowed weightbearing at 2 weeks postoperatively) or the nonweightbearing group (99 patients who were not allowed weightbearing until 6 weeks postoperatively). The primary outcome measure was the mean difference in the Olerud-Molander ankle score (OMAS) between the groups, assessed at the 12-month follow-up examination. The secondary outcome measures were the time to return to preinjury activities and patients’ subjective satisfaction. Complications such as hardware loosening or failure, fracture displacement, and nonunion were evaluated. Results: The mean difference in the OMAS for the early weightbearing group compared with the nonweightbearing group was 1.6 (95% CI, –1.9 to 5.0) in the intention-to-treat analysis. The lower limit of the 95% CI (–1.9) exceeded the noninferiority margin of –8, indicating that early weightbearing was not inferior to nonweightbearing. The difference in the proportion of patients who were satisfied or very satisfied with their treatment was not statistically significant (84.3% vs 76.2%; P = .19); however, the time taken to return to preinjury activities was shorter with early weightbearing than with nonweightbearing (9.1 ± 3.0 vs 11.0 ± 3.0 weeks; P < .001). No cases of nonunion were observed in either group. Conclusion: Early weightbearing after the operative treatment of an unstable ankle fracture was not inferior to nonweightbearing in terms of OMAS assessed at 12 months after injury. The patients’ subjective satisfaction was similar between the groups, although the time taken to return to preinjury activities was shorter in the early weightbearing group. Registration: NCT02029170 (ClinicalTrials.gov identifier).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Early Weightbearing Versus Nonweightbearing After Operative Treatment of an Ankle Fracture: A Multicenter, Noninferiority, Randomized Controlled Trial

Park

Kim

et al. 2021

Am J Sports Med

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“…Aware of these findings along with the fact that early postoperative weight bearing as well as mobilization is a very controversially discussed topic in the recent literature [ 19 , 24 , 51 – 53 ] the presented results provide a good strategy for a progressive rehabilitation scheme including early weight bearing after a distinct wound healing period. In our opinion the chosen three-week postoperative time interval considered for wound recovery was the key to avoid minor as well as major complications since the distal fibula’s anatomical position is in the subcutaneous tissue without any overlying muscle.…”

Section: Discussionmentioning

confidence: 79%

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

Zyskowski

Wurm

Greve

et al. 2021

BMC Musculoskelet Disord

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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).

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The effect of early weight‐bearing and later weight‐bearing rehabilitation interventions on outcomes after ankle fracture surgery: A systematic review and meta‐analysis of randomised controlled trials

Chen,

Ye,

et al. 2024

Journal of Foot and Ankle Research

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ObjectiveThis systematic review aimed to analyse the effect of early weight bearing versus late weight bearing on rehabilitation outcomes after ankle fractures, which primarily include ankle function scores, time to return to work/daily life and complication rates.MethodsThe China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, China Science and Technology Journal, Web of Science, PubMed, Embase and Cochrane Library databases were searched. The focus was on identifying randomised controlled trials centred on early weight‐bearing interventions for post‐operative ankle fracture rehabilitation. All databases were searched for eligible studies published within the period from database inception to 20 June 2023. The eligible studies were screened according to the inclusion criteria. Study quality was evaluated using the methodology recommended by the Cochrane Handbook for the Systematic Evaluation of Interventions. Two authors independently performed the literature search and data extraction. Eligible studies were subjected to meta‐analyses using Review Manager 5.3. Based on the time points at which post‐operative ankle function was reported in the studies included in this paper, we decided to perform a meta‐analysis of ankle function scores at 6 weeks post‐operatively, 12 weeks post‐operatively, 24–26 weeks post‐operatively and 1 year post‐operatively.ResultsA total of 11 papers, comprising 862 patients, were included. Meta‐analysis indicated that patients receiving early weight‐bearing interventions, which referred to weight‐bearing for 6 weeks post‐operatively, experienced enhancements in ankle function scores (Olerud–Molander score, AOFAS score or Baird–Jackson score) at various post‐operative milestones: 6 weeks (SMD = 0.69, 95% CI: 0.49–0.88 and p < 0.01), 12 weeks (SMD = 0.57, 95% CI: 0.22–0.92 and p < 0.01) and the 24–26 weeks range (SMD = 0.52, 95% CI: 0.20–0.85 and p < 0.01). The results of subgroup analyses revealed that the effects of early weight‐bearing interventions were influenced by ankle range‐of‐motion exercises. Additionally, early weight bearing allows patients to return to daily life and work earlier, which was evaluated by time when they resumed their preinjury activities (MD = −2.74, 95% CI: −3.46 to −2.02 and p < 0.01), with no distinct elevation in the incidence of complications (RR = 1.49, 95% CI: 0.85–2.61 and p > 0.05).ConclusionThe results showed that early weight bearing is effective in improving ankle function among post‐operative ankle fracture patients and allows patients to return to daily life earlier. Significantly, the safety profile of early weight bearing remains favourable, with no higher risk of complications than late weight bearing.

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Safety of Early Weight Bearing Following Fixation of Bimalleolar Ankle Fractures

Cited by 12 publications

References 27 publications

Early Weightbearing Versus Nonweightbearing After Operative Treatment of an Ankle Fracture: A Multicenter, Noninferiority, Randomized Controlled Trial

Early Weightbearing Versus Nonweightbearing After Operative Treatment of an Ankle Fracture: A Multicenter, Noninferiority, Randomized Controlled Trial

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

The effect of early weight‐bearing and later weight‐bearing rehabilitation interventions on outcomes after ankle fracture surgery: A systematic review and meta‐analysis of randomised controlled trials

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