How long should patients be kept non-weight bearing after ankle fracture fixation? A survey of OTA and AOFAS members. Issue 6 (June 2015)

• Record Type: Journal Article
• Authors: Swart, Eric; Bezhani, Hariklia; Greisberg, Justin; Vosseller, J. Turner
• Is Part Of: Injury. Volume 46:Issue 6(2015)
• Page Start: 1127
• Page End: 1130
• Publication Date: 2015-06
• Subjects: Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2015.03.029
• Languages: English
• ISSNs: 0020-1383

Abstract

<abstract abstract-type="author" id="abs0005"> <title id="sect0005">Abstract</title> <sec> <title id="sect0010">Background</title> <p id="spar0005">Ankle fractures are common injuries treated routinely by orthopaedic surgeons. A variety of different post-operative protocols have been described with differing periods of non-weight bearing after surgery. The aim of this study was to identify how patient injury characteristics and medical comorbidities contribute to the period of non-weight bearing chosen by orthopaedic surgeons after open reduction and internal fixation of rotational ankle fractures.</p> </sec> <sec> <title id="sect0015">Methods</title> <p id="spar0010">A cross sectional expert opinion survey was administered to members of the AOFAS as well as OTA to determine how long they would instruct patients to be non-weight bearing after open reduction and internal fixation of ankle fractures. Three different injury characteristics were described: supination external rotation type 4 equivalents, bimalleolar, and trimalleolar patterns. These patterns were combined with three different medical statuses: young and healthy, older and healthy, and older with significant medical comorbidity. Respondents selected how long they would keep the patient non-weight bearing after surgery for each of the potential scenarios. Finally, they were directly asked which factors they felt affected their decision about length of time to keep patients non-weight bearing.</p> </sec> <sec> <title id="sect0020">Results</title> <p id="spar0015">Seven hundred and two surgeons (31%) responded to the survey. The average time of non-weight bearing selected varied from 4.9 (±3.1) weeks for in young, healthy patients with SER4 equivalent injuries to 7.6 (±6.0) weeks for older patients with medical comorbidities with trimalleolar fractures. Responses had a high degree of heterogeneity, but both injury pattern and medical status were significant predictors of non-weight bearing period (<italic>p</italic> < 0.01), with medical status the stronger determinant.</p> </sec> <sec> <title id="sect0025">Conclusions</title> <p id="spar0020">There is significant variation among orthopaedic surgeons when selecting period of non-weight bearing after fixation of ankle fractures, with both injury pattern and medical comorbidity playing a role in decision of time to keep patient non-weight bearing. Further research further evaluating the relationship between these factors and safe periods of non-weight bearing could help identify patients that may benefit from earlier mobilization, and improve surgeon's comfort with early mobilization.</p> </sec> <sec> <title id="sect0030">Level of evidence</title> <p id="spar0025">Therapeutic Level V.</p> </sec> </abstract>