Objective:
The aim of this study was to compare two post-operative protocols, immobilisation versus early weight bearing following open reduction internal fixation of the ankle.
Methods:
A prospective observational study of ankle ORIF patients (n=16) was conducted with comparison of outcomes measures between those following a NWB protocol for six weeks versus a WB protocol from day one post operatively.
Patients were recruited through St James’s hospital orthopaedic service between June and September 2015 (n=16).
The following outcome data were collected at six and twelve weeks : Ankle range of movement using a goniometer, pain score using the Visual Analogue Scale (VAS), lower extremity functional scale score (LEFS) and use of crutches.
Ethical approval was obtained from the AMNCH (Tallaght) Hospital/ St James’s Hospital Joint Research Ethics Committee (REC).
Data were entered onto the statistical software package SPSS for Windows 7 Version 20 for analysis. Shapiro- Wilk normality test (p>0.5) determined data were not normally distributed. Data were analysed using descriptive statistics and median and interquartile range were reported. Between group differences were evaluated using the Mann Whitney U Tests and Fisher Exact Tests. P value <0.05 were considered significant.
Results: At six and twelve weeks: ankle dorsiflexion and plantar flexion were greater in the WB group than the NWB group (p=0.16, p=0.57) (p=0.44, p=0.87); pain was less in the WB group than NWB group (p=0.32, p=0.10);LEFS score was greater in WB group than the NWB group (p=0.23, p=0.64). Use of crutches was less in the WB group than the NWB group (p=0.01, p=0.72).
Conclusion:
No significant difference was found between NWB and WB post ankle ORIF, however the weight bearing group returned to independent mobility faster than the non-weight bearing group.
References
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Starkweather, M.P, Collman, D.R and Schuberth, J.M. Early protected weightbearing after open reduction internal fixation of ankle fractures. The Journal of Foot and Ankle Surgery 2012; 51: 575-578.
Smith, T.O and Davies, L. When should open reduction and internal fixation ankle fractures begin weight bearing? A systematic review. European Journal of Trauma and Emergency Surbery 1998; 1: 69-76.
Simanski, C.J.P, Maegele, M.G, Lefering et al.Functional treatment and early weight bearing after an ankle fracture. Journal of Orthopaedic Trauma 2006; 22: 108-114.
NICE guidelines development group. Fractures (non complex): assessment and management 2016 1-16.
