Early weight bearing after ankle ORIF

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.

Dehghan N, McKee MD, Jenkinson RJ, et al. Journal of orthopaedic trauma 2016 · PMID 27045369 · doi:10.1097/bot.0000000000000572

Question

After fixation of unstable ankle fractures, does early weight bearing and movement improve recovery compared with non-weight bearing in a cast?

Design

Randomised controlled trial across two Canadian level I trauma centres.

Patients

Adults with unstable ankle fractures treated with open reduction and internal fixation.

Intervention

Weight bearing and range of motion from 2 weeks post-op

Comparison

Non-weight bearing with immobilisation for 6 weeks

Primary outcome

Time to return to work

Key result

Return to work did not differ between groups, but early weight bearing gave better ankle range of motion and early functional outcome at 6 weeks, without an increase in complications.

Limitations

Unblinded, modest sample from two centres, so underpowered for uncommon complications such as fixation failure.

Impact on practice

Supports allowing early protected weight bearing after stable ankle fracture fixation rather than routine 6 weeks of non-weight bearing.