IMMEDIATE UNPROTECTED WEIGHT-BEARING OF OPERATIVELY TREATED ANKLE FRACTURES

Abstract

The objective of this study was to determine whether immediate mobilisation and unprotected weight bearing of rigidly internally fixed fractured ankles had a significant effect on ankle function or whether it predisposed the ankle to loss of reduction or hardware failure.

We retrospectively reviewed eighty-nine patients with unstable and/or displaced Weber type-A, B or C ankle fractures. Twenty ankle fractures who underwent open reduction and internal fixation. Post operatively the patients were either treated in a non-weight bearing plaster cast (Group A) or were allowed immediate full weight bearing as tolerated without a plaster (Group B. The treatment or weight bearing status was not modified for patients with syndesmosis injuries or deltoid ligament repair. For comparison, twenty-five patients of each group were matched to a same number of historic controls with respect to age, gender, body mass index, and fracture type.

The recovery of the patients was assessed clinically with use of subjective, objective, and radiographic evaluation criteria with reviews at ten to fourteen days, six weeks and three months and one year after the operation. The follow up ranged from twenty-four to fifty-eight months with an average follow up of 37.5 months. Matched-pair analysis revealed no differences for hospital stay and functional outcome (p= 0.858) on Olerud and Molander scoring system but significant difference in time until return to work (mean 91.3 ±20.2 vs. 54.6 ±15.5 days). In the cast group; one patient had loss of internal fixation and one had non-union while four patients in non cast group had mainly wound-healing related problems. Patients in non cast group tolerated earlier full weightbearing and there were no disadvantages concerning hospital stay, pain intensities, and functional Scores.

We conclude that immediate mobilisation and unprotected weight bearing of rigidly internally fixed fractured ankles does not predispose the ankle to loss of reduction or hardware failure and the functional results compared with the conventional cast immobilisation are comparable. In our opinion early mobilization without plaster is recommended in certain populations and may result in faster rehabilitation.