Early protected weightbearing after open reduction internal fixation of ankle fractures.

The present retrospective study assessed the complications and loss of reduction in 126 patients aged 16 years or older who bore weight in a short leg cast within 15 days after surgical repair of acute unilateral closed ankle fractures from January 1997 to December 2003. Fracture reduction was assessed on immediate postoperative and weightbearing digital radiographs at least 6 weeks after surgery. The medical records were reviewed for postoperative complications. Complete radiographs were available for 81 patients. The mean follow-up period was 171 (range 42 to 1275) days. The mean patient age was 50 years. Patients began walking an average of 8 days after surgery. From the medical record review, no cases of malunion or nonunion occurred. A total of 14 complications developed in 12 (9.5%) of 126 patients, including a delay in wound healing in 6, nerve paresthesia in 5, and hardware migration in 1. The patients aged 60 years or older had a slightly greater overall complication rate (6 of 38, p = .18). Patients who walked on postoperative day 1 had slightly more wound problems (2 of 19, p = .36). Of the 81 ankle fracture radiographs, 80 (98.8%) showed no displacement in fracture reduction on the final follow-up examination. One patient had a 2-mm loss of fracture reduction and was allowed to walk on postoperative day 1 (p = .09). These results support early protected weightbearing after operative treatment of closed isolated lateral malleolar and bimalleolar ankle fractures without syndesmotic involvement in patients of all ages.

[1]  J. Schuberth,et al.  Complications after open reduction and internal fixation of ankle fractures in the elderly. , 2012, Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons.

[2]  C. Ekdahl,et al.  Outcome and quality of life after surgically treated ankle fractures in patients 65 years or older , 2007, BMC musculoskeletal disorders.

[3]  P. Hecht,et al.  Complications after Ankle Fracture in Elderly Patients , 2007, Foot & ankle international.

[4]  E. Strauss,et al.  The management of ankle fractures in the elderly. , 2007, Injury.

[5]  S. Mehmood,et al.  Immediate unprotected weight-bearing of operatively treated ankle fractures. , 2007, Acta orthopaedica Belgica.

[6]  L. Audigé,et al.  Aftertreatment of malleolar fractures following ORIF—functional compared to protected functional in a vacuum-stabilized orthesis: a randomized controlled trial , 2007, Archives of Orthopaedic and Trauma Surgery.

[7]  R. Lefering,et al.  Functional Treatment and Early Weightbearing After an Ankle Fracture: A Prospective Study , 2006, Journal of orthopaedic trauma.

[8]  J. Schuberth,et al.  Deltoid ligament integrity in lateral malleolar fractures: a comparative analysis of arthroscopic and radiographic assessments. , 2004, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[9]  T. Järvinen,et al.  Use of a Cast Compared with a Functional Ankle Brace After Operative Treatment of an Ankle Fracture: A Prospective, Randomized Study , 2003, The Journal of bone and joint surgery. American volume.

[10]  H. Zwipp,et al.  Funktionell ausgerichtete Nachbehandlung von Osteosynthesen des oberen Sprunggelenkes mit dem flexiblen Arthrodesenstiefel (Variostabil®) , 2002 .

[11]  C. Moran,et al.  Internal fixation of ankle fractures in the very elderly. , 2001, Injury.

[12]  J. Michelson,et al.  Results of Operative Fixation of Unstable Ankle Fractures in Geriatric Patients , 2001, Foot & ankle international.

[13]  W. Harper,et al.  Conservative versus operative treatment for displaced ankle fractures in patients over 55 years of age. A prospective, randomised study. , 2001, The Journal of bone and joint surgery. British volume.

[14]  C. Jensen,et al.  Successful immediate weight-bearing of internal fixated ankle fractures in a general population , 2000, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[15]  K. Vandenborne,et al.  Effects of immobilization on plantar-flexion torque, fatigue resistance, and functional ability following an ankle fracture. , 2000, Physical therapy.

[16]  K. Koval,et al.  Functional outcome of surgery for fractures of the ankle. A prospective, randomised comparison of management in a cast or a functional brace. , 2000, The Journal of bone and joint surgery. British volume.

[17]  M. Salai,et al.  The epidemic of ankle fractures in the elderly – is surgical treatment warranted? , 2000, Archives of Orthopaedic and Trauma Surgery.

[18]  J. Michelson,et al.  Ankle Fractures: The Lauge-Hansen Classification Revisited , 1997, Clinical orthopaedics and related research.

[19]  C. V. van Laarhoven,et al.  Postoperative treatment of internally fixed ankle fractures: a prospective randomised study. , 1996, The Journal of bone and joint surgery. British volume.

[20]  H. Tropp,et al.  Ankle Performance after Ankle Fracture: A Randomized Study of Early Mobilization , 1995, Foot & ankle international.

[21]  W. Leach,et al.  Audit of ankle fracture fixation in the elderly. , 1994, Journal of the Royal College of Surgeons of Edinburgh.

[22]  R. Maniar,et al.  A comparative study of early motion and immediate plaster splintage after internal fixation of unstable fractures of the ankle. , 1993, Injury.

[23]  L. Klenerman,et al.  Ankle fractures in the elderly: MUA versus ORIF. , 1993, Injury.

[24]  A. Lundberg,et al.  Early mobilization of operated on ankle fractures. Prospective, controlled study of 40 bimalleolar cases. , 1993, Acta orthopaedica Scandinavica.

[25]  P. Slabaugh,et al.  Early mobilization of ankle fractures after open reduction and internal fixation. , 1991, Clinical orthopaedics and related research.

[26]  L. Engebretsen,et al.  Early postoperative weight-bearing and muscle activity in patients who have a fracture of the ankle. , 1989, The Journal of bone and joint surgery. American volume.

[27]  G. Selvik,et al.  Mobilization after operation of ankle fractures. Good results of early motion and weight bearing. , 1988, Acta orthopaedica Scandinavica.

[28]  G. Selvik,et al.  Early weight bearing of displaced ankle fractures. , 1987, Acta orthopaedica Scandinavica.

[29]  J. Litchfield,et al.  The treatment of unstable fractures of the ankle in the elderly. , 1987, Injury.

[30]  C. McLaren,et al.  Ankle Fractures in the Elderly: Nonoperative or Operative Treatment , 1987, Journal of orthopaedic trauma.

[31]  G. Selvik,et al.  Early weight bearing of malleolar fractures. , 1986, Acta orthopaedica Scandinavica.

[32]  A. Alho,et al.  Immobilization of operated ankle fractures. , 1986, Acta orthopaedica Scandinavica.

[33]  H. Schwartz,et al.  A prospective, randomized study of the management of severe ankle fractures. , 1985, The Journal of bone and joint surgery. American volume.

[34]  D. Pee,et al.  Quantitative criteria for prediction of the results after displaced fracture of the ankle. , 1983, The Journal of bone and joint surgery. American volume.

[35]  C. Beauchamp,et al.  Displaced ankle fractures in patients over 50 years of age. , 1983, The Journal of bone and joint surgery. British volume.

[36]  J. Yde,et al.  Ankle fractures: supination-eversion fractures of stage IV. Primary and late results of operative and non-operative treatment. , 1980, Acta orthopaedica Scandinavica.

[37]  C. A. Cedell,et al.  Supination-outward rotation injuries of the ankle. A clinical and roentgenological study with special reference to the operative treatment. , 1967, Acta orthopaedica Scandinavica.

[38]  N. LAUGE-HANSEN,et al.  Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. , 1950, Archives of surgery.