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Results of randomized study support early weight-bearing after operative fixation of unstable ankle fractures

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NEW ORLEANS —Data that were presented by investigators from Toronto, here, at the American Academy of Orthopaedic Surgeons Annual Meeting, disputed the conventional notion that weight-bearing following fixation of unstable ankle fractures should be delayed.

“Early weight-bearing has the potential to decrease the time to return to work,” Niloofar Dehghan, MD, FRCS, said.

In a randomized controlled trial that was conducted at two Canadian trauma centers, Dehghan and colleagues studied 110 patients with an ankle fracture. They divided the patients into two groups: 56 patients in the early weight-bearing (EWB) group and 54 patients in the delayed weight-bearing (DWB) group. The EWB group was given a functional boot to wear and could begin weight-bearing and range of motion exercises at 2 postoperative weeks. The DWB group followed this step at 6 postoperative weeks.

Among patients in both groups, 40% returned to work by 6 weeks and 90% returned to work by 6 months postoperatively. All patients could return to work by 12 months.

According to Dehghan, “There was no significant difference between the groups (returning to work) at any time point.”

Ankle range of motion and the Olerud-Moleander scores were better in the EWB group than the DWB group at 6 weeks postoperatively, based on the results. Dehghan and colleagues observed no significant difference in these outcomes between the groups beyond 6 weeks.

Furthermore, complication rates were minimal and not statistically significant in either group.

 “Given the early improved functional outcomes, as well as no real evidence of complication in regards to wound infection or hardware failure, we highly recommend early weight-bearing and early range of motion ankle exercises after surgical fixation of ankle fractures,” Dehghan said.

Reference:

Dehghan N. Paper #63. Presented at the: American Academy of Orthopaedic Surgeons Annual Meeting; March 11-15, 2014; New Orleans.

Disclosure: Dehghan has no relevant financial disclosures.