title: Rest easy? Is bed rest really necessary after surgical repair of an ankle fracture?
abstract: BACKGROUND
  Bed rest with elevation of the affected limb is commonly prescribed postoperatively following ankle fracture fixation although there is no evidence that this is necessary.
  
  
  OBJECTIVE
  The aim of this prospective, randomised study was to investigate the effects of early mobilisation following surgical fixation of an ankle fracture on wound healing and length of stay (LOS).
  
  
  METHODS
  A total of 104 patients underwent primary internal fixation of an ankle fracture at The Alfred hospital, Melbourne between July 2008 and January 2010.
  
  
  METHODS
  The strategy included either early mobilisation group (first day post surgery) or control group (bed rest with elevation until day 2 post surgery).
  
  
  METHODS
  Data collected included demographic, injury type and surgical procedure. Outcome data included inpatient LOS, wound condition at 10-14 days, opioid use and re-admission rate.
  
  
  RESULTS
  Groups were comparable at baseline. Wound breakdown rate was 2.9% (3 patients in the control group). Median LOS of the early mobilisation group was 55 h compared with 71 h in the control group (p<0.0001). Opioid use for the control group was an average of 90 mg morphine equivalent in the first 24 h post surgery compared with 67 mg morphine equivalent for the early mobilisation group (p=0.32).
  
  
  CONCLUSIONS
  This study indicates that early mobilisation following surgical fixation of an ankle fracture results in a shorter hospital stay without evidence of an increased risk of re-admission or wound complication.
authors.affiliation: Department of Physiotherapy, The Alfred Hospital, Melbourne, Australia. l.kimmel@alfred.org.au
authors.forename: Lara A
authors.initials: LA
authors.lastname: Kimmel
authors.forename: Elton R
authors.initials: ER
authors.lastname: Edwards
authors.forename: Susan M
authors.initials: SM
authors.lastname: Liew
authors.forename: Leonie B
authors.initials: LB
authors.lastname: Oldmeadow
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Webb
authors.forename: Anne E
authors.initials: AE
authors.lastname: Holland
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D001315:Australia / Q000453:epidemiology; D001510:Bed Rest / Q000191:economics; D004434:Early Ambulation; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D050723:Fractures, Bone / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D013997:Time Factors; D055815:Young Adult