Rehabilitation for ankle fractures in adults

Abstract

Ankle fracture is one of the most common fractures of the lower limb, especially in older women and young men. It is generally treated surgically or non-surgically, followed by a period of immobilisation to prevent complications such as malunion. Because of the fracture and the subsequent immobilisation period, people often experience pain, stiffness, weakness and swelling at the ankle, and a reduced ability to participate in activities. This review looked at the evidence on the effects of different rehabilitation interventions for these fractures. Rehabilitation for ankle fracture can begin soon after the fracture has been treated, either surgically or non-surgically, by the use of different types of immobilisation that allow early commencement of weight-bearing or exercise. Alternatively, rehabilitation, including the use of physical or manual therapies, may start following the period of immobilisation. Thirty-eight studies with a total of 1,896 participants were included in the review. Many of the trials were potentially biased. Three studies examined rehabilitation interventions that started during the immobilisation period after non-surgical treatment. There is some very limited evidence of short term benefit of one type of brace compared with immobilisation with a cast or orthosis. There was no evidence for hypnosis. Thirty studies investigated rehabilitation interventions that started during the immobilisation period after surgical treatment. Ten of these compared the use of a removable type of immobilisation combined with exercise with cast immobilisation alone. There is some evidence from these that using a removable brace or splint so that gentle ankle exercises can be performed during the immobilisation period may enhance the return to normal activities, reduce pain and improve ankle movement. However, the incidence of adverse events (such as problems with the surgical wound) may also be increased. Starting walking early may also slightly improve ankle movement. One small and biased study showed that neurostimulation, an electrotherapy modality, may be beneficial in the short-term. There was little and inconclusive evidence on what type of support or immobilisation was the best. Five studies investigated different rehabilitation interventions that started after the immobilisation period. There is no evidence of improved function for stretching or manual therapy when either of these are added to an exercise programme, or for an exercise programme when this is compared with usual care. One small and potentially biased study found reduced ankle swelling after non-thermal compared with thermal pulsed shortwave diathermy.