DOES EARLY MOBILIZATION OF OPERATIVELY FIXED ANKLE FRACTURES IMPROVE OUTCOME: A SYSTEMATIC REVIEW

Abstract

Background: It is commonly believed that early motion after joint fixation is a good thing, especially in the upper limb, but in the ankle joint this is much less clear. No previous systematic review of the evidence for this could be found in the literature.

Materials and Methods: Nine randomised Control Trials were identified which met the inclusion criteria and compared early motion of the ankle joint to immobilisation in a cast for six weeks. These varied in quality and numbers. All treated patients equally in all other respects including weight bearing. Where outcome measures were similar, some meta-analysis was possible.

Results: There is good evidence that early motion results in a quicker return to work on average (p=0.008) and results in improved range of motion at 12 weeks (dorsiflexion p= 0.001; plantarflexion p < 0.00001) compared to cast immobilisation. However it also results in an increased risk of wound infection (p=0.002). There is a suggestion that early motion results in a lower rate of deep vein thrombosis, but this is not quite significant (p=0.12). There is no evidence that it results in improved joint specific outcome scores or range of motion at 1 year.

Discussion: It is difficult to state that early motion is better or worse than cast immobilisation for every patient. The evidence suggests however that a young fit patient who needs to return to work may benefit from early motion of the ankle joint whereas an older diabetic patient with poor skin would be better treated in cast.