Time to weight-bearing may not lead to complications in ankle fracture
Key takeaways:
- Time to weight-bear showed no significant link with complication rates after fixation for ankle fracture.
- More research is needed to identify which patients should be kept non-weight-bearing longer.
Published results showed time to weight-bearing after open reduction and internal fixation in patients with ankle fractures showed no statistical significance with complication rates.
“The results show that there was no statistical difference between timing to weight-bear and complications in ankle fractures,” Kyle M. Schweser, MD, FAAOS, assistant professor of orthopedic trauma and director of foot and ankle in the department of orthopedic surgery at the University of Missouri, told Healio. “In other words, if patients were going to develop a complication, it seems to be unrelated to when they are allowed to bear weight.”
Schweser and colleagues retrospectively categorized 233 patients with isolated (27%) or complex (73%) ankle fractures who underwent open reduction and internal fixation between March 1, 2020, and Jan. 19, 2022, into groups based on whether began to weight-bear postoperatively at less than 3 weeks (early weight-bearing group; n = 74), between 3 and 6 weeks (intermediate weight-bearing group; n = 60) or at more than 6 weeks (delayed weight-bearing group; n = 99). Researchers considered rates of complications requiring reoperation and minor complications as main outcome measures.
Comparison showed the three weight-bearing groups had no significant differences in overall rates of complications or complications requiring reoperation. Schweser and colleagues also found no significant differences in overall rates of complications or complications requiring reoperation between the complex fracture group and the isolated malleolar fracture group.
However, researchers found the early weight-bearing group had the lowest proportion of patients with diabetes, neuropathies and syndesmosis fixation, while the delayed weight-bearing group had the highest rate of patients with an American Society of Anesthesiologists score of 3 or 4.
When reviewing fracture type, women had increased odds of sustaining a complex fracture and of having overall complications, according to Schweser and colleagues. However, they found women did not have increased odds of having complications requiring reoperation. Results showed patients in the complex fracture group had a significantly older median age, longer median non-weight-bearing time and greater odds of having initial external fixation compared with the isolated fracture group.
“This adds to the overall research that early weight-bearing after ankle fractures is safe, and that surgeons should allow even complex ankle fractures to walk early in their recovery,” Schweser said. “However, this is a retrospective review, and we were underpowered to fully examine comorbidities and their link to complications in specific fracture patterns. More studies are needed to fully elucidate which patients should be kept non-weight-bearing longer. That is in contrast to which patients should be allowed to bear weight early, which seems to be the increasingly larger group with expanding inclusions.”
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