Immediate Weight-Bearing and Range of Motion After Internal Fixation of Selected Malleolar Fractures: A Retrospective Controlled Study. Issue 6 (June 2021)
- Record Type:
- Journal Article
- Title:
- Immediate Weight-Bearing and Range of Motion After Internal Fixation of Selected Malleolar Fractures: A Retrospective Controlled Study. Issue 6 (June 2021)
- Main Title:
- Immediate Weight-Bearing and Range of Motion After Internal Fixation of Selected Malleolar Fractures
- Authors:
- Fram, Brianna R.
Rogero, Ryan G.
Chang, Gerard
Krieg, James C.
Raikin, Steven M. - Abstract:
- Abstract : Objectives: We studied the safety of immediate weight-bearing as tolerated (IWBAT) and immediate range of motion (IROM) after open reduction internal fixation (ORIF) of selected malleolar ankle fractures (defined as involving bony or ligamentous disruption of 2 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: Of 268 patients at our level 1 trauma center who underwent primary ORIF of a selected malleolar fracture from 2013 to 2018, 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 postoperatively. The groups did not differ significantly in age, body mass index, 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 versus NWB for 6 weeks. Main Outcome Measurements: Postoperative complications, including delayed wound healing, superficial or deep infection, and loss of reduction.Abstract : Objectives: We studied the safety of immediate weight-bearing as tolerated (IWBAT) and immediate range of motion (IROM) after open reduction internal fixation (ORIF) of selected malleolar ankle fractures (defined as involving bony or ligamentous disruption of 2 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: Of 268 patients at our level 1 trauma center who underwent primary ORIF of a selected malleolar fracture from 2013 to 2018, 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 postoperatively. The groups did not differ significantly in age, body mass index, 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 versus NWB for 6 weeks. Main Outcome Measurements: Postoperative 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 a loss of reduction ( P = 0.89). We did not identify any factors associated with an increased complication risk, including posterior malleolus or syndesmosis fixation, diabetes, age, or preinjury-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. Abstract : Supplemental Digital Content is Available in the Text. … (more)
- Is Part Of:
- Journal of orthopaedic trauma. Volume 35:Issue 6(2021)
- Journal:
- Journal of orthopaedic trauma
- Issue:
- Volume 35:Issue 6(2021)
- Issue Display:
- Volume 35, Issue 6 (2021)
- Year:
- 2021
- Volume:
- 35
- Issue:
- 6
- Issue Sort Value:
- 2021-0035-0006-0000
- Page Start:
- Page End:
- Publication Date:
- 2021-06
- Subjects:
- ankle fracture -- open reduction internal fixation -- postoperative protocols -- immediate weight-bearing as tolerated -- immediate range of motion
Orthopedics -- Periodicals
Wounds and injuries -- Periodicals
Orthopedics -- Periodicals
Wounds and Injuries -- therapy -- Periodicals
Periodicals
617.47044 - Journal URLs:
- http://journals.lww.com/jorthotrauma/pages/default.aspx ↗
http://www.jorthotrauma.com ↗
http://cufts2.lib.sfu.ca/CJDB/BVAS/journal/149202 ↗
http://gateway.ovid.com/ovidweb.cgi?T=JS&MODE=ovid&PAGE=toc&D=ovft&AN=00005131-000000000-00000 ↗
http://journals.lww.com ↗ - DOI:
- 10.1097/BOT.0000000000002003 ↗
- Languages:
- English
- ISSNs:
- 0890-5339
- Deposit Type:
- Legaldeposit
- View Content:
- Available online (eLD content is only available in our Reading Rooms) ↗
- Physical Locations:
- British Library DSC - 5027.675000
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British Library STI - ELD Digital store - Ingest File:
- 18956.xml