Research backs early weight-bearing after ankle fracture in selected patients

MINNEAPOLIS – Early weight-bearing is a safe rehabilitation protocol in selected patients following ankle fracture and resulted in no cases of lost reduction, according to a study presented here.

“Early weight-bearing has long been shown to be a reasonable strategy following ankle fracture with a number of potential benefits to patients. Despite this, a number of surgeons do not routinely permit their patients to weight-bear early. In this large cohort study, we have shown that routine early weight-bearing is a safe management protocol in appropriately selected patients,” Kate E. Bugler, BA, MCRS of the Royal Infirmatory Edinburgh, Scotland, said during her presentation at the Orthopaedic Trauma Association Annual Meeting 2012.

Bugler and colleagues prospectively studied all patients who had ankle fractures treated at their center during a 15-month period. They excluded patients from the study who had peripheral nerve dysfunction, syndesmotic injuries, unstable fixation and associated injuries that required a period of non-weight-bearing. They also excluded children with Salto-Harris injuries, patients who were unable to comply with rehabilitation protocols, or abused alcohol or intravenous drugs.

Kate E. Bugler

Of the 847 patients included in the study, surgeons judged two-thirds of the patients to have stable fractures that were treated nonoperatively with plaster casts, moon boots or soft bandages. Ninety-seven percent of these patients were permitted to early weight-bear.

“All patients showed good fracture reduction on final radiographic review and maintenance of the anatomical mortis,” Bugler said.

The remaining 33% of patients had unstable fractures that underwent fracture fixation dependent upon the treating surgeon. Researchers excluded 114 patients in this group, most due to syndesmotic injury. The remaining 162 patients were permitted early routine weight-bearing. Radiographs showed maintenance of the anatomical mortis and fracture reduction at the time of union in all but five cases.

“These five cases should have been excluded from routine early weight-bearing,” Bugler said. “Two were patients with syndesmotic fixation with early weight-bearing resulting in late recurrence of the diastasis. The other three patients were unable to comply with the instructions due to psychological issues, alcohol excess and peripheral neuropathy, respectively.”

Reference:

Bugler KE, White TO. Early routine weight-bearing is safe in patients with ankle fractures. Paper #40. Presented at the Orthopaedic Trauma Association Annual Meeting 2012. Oct. 3-6. Minneapolis.

Disclosure: Bugler has no relevant financial disclosures.