Session II - Foot and Ankle

Functional Outcome following Ankle Fracture Surgery: A Prospective, Randomized Comparison of Two Treatment Protocols

Kenneth A. Egol, MD; Kenneth J. Koval, MD, New York University - Hospital for Joint Diseases, New York, NY

To compare the effects of immobilization versus early range of motion on the functional outcome of operatively treated ankle fractures, 60 consecutive patients who met inclusion criteria and underwent ankle fracture surgery were prospectively randomized to one of two treatment groups. Group 1 was randomized to a short leg cast, and group 2 was randomized to a functional brace and early range of motion. All patients were non-weightbearing. Patients were seen at 6, 12, 26 and 52 weeks. A functional rating scale of Mazur et. al. was used to evaluate patients at each follow up, and return to work status was recorded. SF-36 questionnaires were recorded at one year. Statistical evaluation was performed using t-tests and Mann-Whitney U tests'; a p-value <0.05 was considered significant.

Fifty-five patients completed one-year follow-up: twenty-eight patients in group 1 and twenty-seven patients in group 2. Patients in group 2 had higher functional scores at each time interval; however, only at 6 weeks was this difference significant (p=.02). Patients treated with a functional brace had higher average SF-36 scores; however, this difference was statistically significant only for 2 of the 8 domains examined. For patients gainfully employed and not on worker's compensation, the time from surgery to return to work averaged 53.3 days for group 2 and 106.5 days for group 1; this difference was significant (p< .01). No patient developed a wound problem or sustained loss of fixation.

These results support the use of a functional brace and early range of motion following ankle fracture surgery.