Preinjury activity, fear of reinjury may impact return to activity after ankle fracture
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Key takeaways:
- Preinjury activity level and fear of reinjury may affect return to activity after ankle fracture repair.
- Sedentary patients were more likely to return to their preinjury level of activity vs. active patients.
While most patients may expect a return to daily activities after ankle fracture repair, presented results showed patients with sedentary preinjury levels of activity may have better odds of returning to normal activity after surgery.
Results also showed fear of reinjury may significantly impact return to activity after ankle fracture repair.
“It's easier to return to being a couch potato who walks occasionally than it is to return to high-intensity athletics involving running, jumping, cutting and pivoting,” Steven M. Hadley Jr., BA, a second-year medical student at Northwestern University Feinberg School of Medicine, said in his presentation at the American Orthopaedic Foot & Ankle Society Annual Meeting. “But again, if the fracture is fixed properly, why aren't more of these patients returning to their baseline activity?”
To assess the impact of preinjury activity level and fear of reinjury on return to activity, Hadley and colleagues performed a retrospective cohort study with data from 703 patients who underwent surgical repair of an ankle fracture with a minimum 1-year follow-up. Among the cohort, 218 patients completed a postoperative questionnaire about their activity levels before and after surgery.
Overall, Hadley and colleagues found 70% of patients reported returning to normal levels of activity after surgery. They found preinjury activity level was significantly associated with return to activity. Results showed 81.9% of patients who reported a sedentary or light preinjury level of activity were able to return to normal activity levels, while 60.5% of patients who reported a high preinjury level of activity were able to return to normal activity levels.
However, when excluding patients who reported activity limitations due to fear of reinjury, Hadley and colleagues found no statistically significant association between preinjury activity level and return to activity. They also found no association between patients who had a Weber fracture subtype (n = 200) and return to activity.
To conclude, appropriate surgical fixation and anatomic reduction results in most patients being able to return to the baseline activity level regardless of their preinjury activity level and regardless of the fracture subtype when not accounting for fear,” Hadley said. “In patients with higher activity levels, fear is playing a significant role, and when fear of reinjury is eliminated, these patients are able to return to their baseline activity.”
“We are totally missing the psychological component of recovery that's significantly impacting our outcomes,” Hadley concluded.
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Hadley Jr. SM, et al. Does preinjury level of activity impact post-recovery activity level regardless of ankle fracture type? Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting; Sept. 11-14, 2024; Vancouver, British Columbia, Canada (hybrid meeting).
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