Abstract
Ankle fractures are common orthopedic injuries. Although operative indications and subsequent stabilization of these fractures have not significantly changed, postoperative protocols remain highly variable. Effects of early weight bearing (EWB) on fracture characteristics in operatively stabilized bimalleolar and bimalleolar equivalent ankle fractures remain poorly publicized. This study seeks to clarify postoperative fracture union rates, rates of hardware loosening or failure, and radiographic medial clear space changes when comparing EWB to late weight bearing (LWB) following open reduction and internal fixation (ORIF).A total of 95 patients with either bimalleolar (66%) or bimalleolar equivalent (34%) fractures who underwent ORIF were retrospectively reviewed. Weight bearing was allowed at three weeks in the EWB group and when signs of radiographic union were noted in the LWB group. Postoperatively, patients were evaluated at regular intervals for fracture union, signs of implant failure, and evidence of medial clear space widening radiographically.There were 38 patients (40%) in the EWB group and 57 patients (60%) comprising the LWB cohort. There were no significant demographic differences between groups. The EWB group on average began to weight bear at 3.1 + 1.4 weeks postoperatively, whereas the LWB group began at 7.2 + 2.1 weeks postoperatively (p<0.01). Union rate (p=0.51), time to union (p=0.23), and implant failure (p>0.1 at all time intervals) were not notably different between groups. No differences in medial clear space were detected at any postoperative interval between groups (p>0.1 at all time intervals). This study suggests that EWB at three weeks postoperatively does not increase markers of radiographic failure compared to six weeks of non-weight bearing (NWB), which has been regarded as the gold standard of treatment to allow for healing; this may represent an improvement to rehabilitation protocols after bimalleolar ankle ORIF of unstable ankle fractures.
Highlights
The incidence of ankle fractures is approximately 71-187 per 100,000 people per year and is one of the most common injuries treated by orthopedic surgeons [1,2,3,4,5]
This study suggests that early weight bearing (EWB) at three weeks postoperatively does not increase markers of radiographic failure compared to six weeks of nonweight bearing (NWB), which has been regarded as the gold standard of treatment to allow for healing; this may represent an improvement to rehabilitation protocols after bimalleolar ankle open reduction and internal fixation (ORIF) of unstable ankle fractures
Our study suggests no increase in medial clear space at any time interval when comparing the EWB and late weight bearing (LWB) groups and no other negative sequela in the EWB cohort when evaluating fracture union, time to union, or implant failure
Summary
The incidence of ankle fractures is approximately 71-187 per 100,000 people per year and is one of the most common injuries treated by orthopedic surgeons [1,2,3,4,5]. The majority of ankle fractures occur secondary to ground-level falls, but irrespective of the injury mechanism, fracture characteristics often dictate the need for operative stabilization [3]. Osteosynthesis techniques for bimalleolar ankle fractures are relatively well established, but operative planning can be dependent on fracture pattern, surgeon preference, and patient comorbidities. After ankle open reduction and internal fixation (ORIF), six weeks of non-weight bearing (NWB) was thought to be the gold standard to allow optimal immobilization for healing [10,11]. The theoretical risk of fixation failure and loss of reduction secondary to inadequate immobilization and early weight bearing (EWB) drove this traditional protocol [12]
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