Immediate Weight Bearing and Range of Motion After Internal Fixation of Selected Malleolar Fractures: A Retrospective Non-Inferiority Controlled Study.

Abstract:

OBJECTIVES:We studied the safety of immediate weight bearing as tolerated (IWBAT) and immediate range of motion (IROM) following open reduction internal fixation (ORIF) of selected malleolar ankle fractures (defined as involving bony or ligamentous disruption of two or more of the malleoli or syndesmosis without articular comminution), and attempted to identify risk factors for complications. DESIGN:Retrospective case-control study SETTING:: Level 1 Urban Trauma Center and multiple community hospitals, orthopedic specialty hospitals, and outpatient surgicenters within one metropolitan area PATIENTS/PARTICIPANTS:: Out of 268 patients at our level 1 trauma center who underwent primary ORIF of a selected malleolar fracture from 2013-18, we identified 133 (49.6%) who were selected for IWBAT and IROM. We used propensity-score matching to identify 172 controls who were non-weight bearing (NWB) and no range of motion for 6 weeks post-operatively. The groups did not differ significantly in age, BMI, Charleston Comorbidity Index, smoking status, diabetes status, malleoli involved, percentages undergoing medial malleolus (60.9% IWBAT vs. 51.7% NWB), posterior malleolus (24.1% IWBAT, 26.7% NWB), or syndesmosis fixation (41.4% IWBAT, 42.4% NWB, p=0.85). INTERVENTION:IWBAT and IROM after ankle ORIF vs. non-weight bearing for 6 weeksMain Outcome Measurements: post-operative complications, including delayed wound healing, superficial or deep infection, and loss of reduction RESULTS:: There was no significant difference in total complications (p=0.41), nonoperative complications (p=0.53), or operative complications, including loss of reduction (p=0.89). We did not identify any factors associated with increased complication risk, including posterior malleolus or syndesmosis fixation, diabetes, age, or pre-injury assisted ambulation. CONCLUSIONS:We failed to demonstrate a difference in complications in general and loss of reduction in particular when allowing immediate weight bearing/ROM in selected cases of operatively treated malleolar fractures, suggesting this may be safe. Future prospective randomized studies are necessary to determine if immediate weight bearing/ROM is safe and whether it offers any benefits to patients with operatively treated malleolar fractures. LEVEL OF EVIDENCE:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

journal_name

J Orthop Trauma

authors

Fram BR,Rogero RG,Chang G,Krieg JC,Raikin SM

doi

10.1097/BOT.0000000000002003

subject

Has Abstract

pub_date

2020-11-09 00:00:00

eissn

0890-5339

issn

1531-2291

pub_type

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