Orthopedic treatment and early weight-bearing for bimalleolar ankle fractures in elderly patients: Quality of life and complications. Issue 2 (February 2020)

• Record Type: Journal Article
• Authors: Lorente, Alejandro; Palacios, Pablo; Lorente, Rafael; Mariscal, Gonzalo; Barrios, Carlos; Gandía, Antonio
• Is Part Of: Injury. Volume 51:Issue 2(2020)
• Page Start: 548
• Page End: 553
• Publication Date: 2020-02
• Subjects: Ankle fracture -- Bimalleolar fracture -- Weight-bearing -- Elderly patients -- Quality of life -- Complications; 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.2019.11.028
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Early weight-bearing is an effective clinical decision to manage 'Weber's type B ankle fracture in elderly patients. Early weight-bearing in elderly patients increase the quality of life more than the gold standard (non-weight-bearing), which increases the functionality measured with the Barthel Index and the SF-12 questionnaire. Early weight-bearing does not produce more consolidation failures or adverse events than non-weight-bearing. Abstract: Introduction: Non-operative treatment of Weber's type B ankle fractures is essential in elderly patients. However, there is controversy in the post-reduction management of the fracture between the use of early weight-bearing or traditional treatment and non-weight-bearing for 6–8 weeks. There is limited evidence available regarding which rehabilitation regimen should be included. This study aimed to compare the quality of life and the number of complications between the two types of intervention (weight-bearing and non-weight-bearing). Methods: Prospective cohort study. The quality of life was analyzed through the SF-12 and the Barthel Index at 6 weeks, one year and two years. The mean age was 83 ± 3 years in the weight-bearing group and 82 ± 3 in the non-weight-bearing group. In addition, the associated complications and costs were analyzed. Results: A total of 70 patients were assigned in two groups: a control group of 37 patients (nonweight-bearing) and an experimental group of 33 patients (weight-bearing). A significant difference was observed in favor of early weight-bearing in SF-12 both, in the short and long terms (52.9 ± 5.3 vs 64.9 ± 4.6; p < 0.001 and 69.8 ± 4.1 vs 81.0 ± 3.6; p < 0.001). Significant differences were also observed in favor of early loading with respect to the Barthel Index (54.3 ± 4.9 vs 64.2 ± 3.9; p < 0.001 and 70.6 ± 4.2 vs 80.4 ± 3.0; p < 0.001). There were no significant differences in the complication rate between the two groups. Conclusion: Early weight-bearing improves the quality of life and functionality in elderly patients with Weber type B fracture without increasing complications.