Early, Rather than Late, Weight-Bearing and Range-of-Motion Exercise Improved Early Function But Not Time to Return to Work After Surgical Fixation of Unstable Ankle Fractures

Abstract

Dehghan N, McKee MD, Jenkinson RJ, Schemitsch EH, Stas V, Nauth A, Hall JA, Stephen DJ, Kreder HJ. Early weightbearing and range of motion versus non-weightbearing and immobilization after open reduction and internal fixation of unstable ankle fractures: a randomized controlled trial. J Orthop Trauma. 2016 Jul;30(7):345-52. ### Question: In patients who had surgical fixation of unstable ankle fractures, how do early and late weight-bearing and range-of-motion exercise compare for return to work and function? ### Design: Randomized (allocation concealed), unblinded, controlled trial with 12 months of follow-up. ### Setting: 2 trauma centers in Toronto, Ontario, Canada. ### Patients: 110 patients (mean age, 42 years; 54% men) who had isolated, acute, unstable ankle fractures that were treated with stable internal fixation. Exclusion criteria were syndesmotic injuries, posterior malleolar fractures needing fixation, surgical fixation >14 days after injury, grade-III open fractures, tibial plafond fractures, polytrauma, skeletal immaturity, past ipsilateral ankle surgery, nonambulatory status before injury, inability to participate in the intervention or study protocol, or receipt of Workers’ Compensation. 82% of patients provided data for the primary outcome, and ≥84% provided other data at each assessment. ### Intervention: Patients were allocated to early (n = 56) or late (n = 54) weight-bearing and range-of-motion exercise under the direction of physiotherapists. …