Early mobilization in a removable cast compared with immobilization in a cast after operative treatment of ankle fractures: a prospective randomized study.
BACKGROUND
The aim of operative treatment for ankle fractures is to allow early movement after internal fixation. The hypothesis of this study was that early mobilization would improve functional recovery in patients after surgery for ankle fractures.


METHODS
In a prospective randomized controlled study, 66 consecutive patients with ankle fractures that required open reduction and internal fixation (ORIF) were assigned to one of two postoperative regimens: immobilization in a nonweightbearing below-knee cast or early mobilization in a removable cast. Four patients were excluded from the study, leaving 62 for review.


RESULTS
Patients who had early mobilization in a removable cast had higher functional scores (Olerud-Molander and AOFAS) at 9 and 12 weeks postoperatively. They also returned to work earlier (67 days) compared with those treated in nonweightbearing below-knee cast (95 days), p<0.05. There was no statistical difference in Quality of Life (SF-36 Questionnaire) at 6 months between the two groups. We had an approximately 10% postoperative infection trend (one superficial and two deep) in the early mobilization group.


CONCLUSIONS
Despite the overall short-term benefit of early mobilization, we had three patients in the early mobilization group who had wound complications. Both the surgeon and patient should be aware of the higher risk of wound complications associated with this treatment, and thus the accelerated rehabilitation protocol should be individualized.
Vioreanu
Mihai
M
mihaiv@eircom.net
Dudeney
Sean
S
Hurson
Brian
B
Kelly
Eamon
E
O'Rourke
Kieran
K
Quinlan
William
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000534:rehabilitation / Q000601:surgery / Q000628:therapy*; D002370:Casts, Surgical / Q000009:adverse effects; D004434:Early Ambulation; D005260:Female; D005592:Fracture Fixation; D005596:Fractures, Closed / Q000534:rehabilitation / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors