Fri., 10/5/12 Foot & Ankle, PAPER #40, 10:06 am OTA-2012
Early Routine Weight Bearing Is Safe in Patients With Ankle Fractures
Kate Ella Bugler; Timothy O. White, MD, FRCS;
Orthopaedic Trauma Unit, Royal Infirmary Edinburgh, Edinburgh, Scotland, United Kingdom
Background/Purpose: Early weight bearing of patients with ankle fractures is associated with good outcomes. There are a number of potential advantages to early mobilization including reduced hospital stay, and earlier return to work and return to regular daily activities. However, many surgeons have not incorporated this into their routine ankle fracture protocol, particularly for patients managed operatively, potentially due to concerns regarding loss of reduction. We hypothesized that ankle fractures managed fully weight bearing would have good outcomes and a low rate of loss of reduction.
Methods: All ankle fractures presenting to our orthopaedic trauma department over a 15-month period were studied prospectively. Patients were instructed to mobilize fully weight bearing as able, either immediately postoperatively (for those fractures considered unstable that underwent operative intervention), or at the first fracture clinic review (if stable and managed conservatively). Only patients with syndesmotic injuries and those with neuropathy or psychiatric illness were excluded. The effectiveness of this management protocol was assessed by clinical and radiographic review following fracture union.
Results: 650 patients were included, with a mean age of 49 years, of whom 25% were over the age of 65 years. 35% of fractures were unstable and therefore managed operatively; 65% were stable and therefore managed in casts or with functional bracing. In every case, the radiographs showed maintenance of anatomic mortise and fracture reduction at the time of union.
Conclusion: Early weight bearing of patients with ankle fractures, whether managed conservatively or operatively, results in very low rates of loss of reduction and should be considered routine management for the majority of patients.Alphabetical Disclosure Listing (808K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.