title: Weight-bearing and mobilization in the postoperative care of ankle fractures: a systematic review and meta-analysis of randomized controlled trials and cohort studies.
abstract: OBJECTIVE
  To determine the effectiveness and safety of interventions used for rehabilitation after open reduction and internal fixation of ankle fractures.
  
  
  METHODS
  A systematic review and meta-analysis was performed using both randomized trials and cohort studies. The effect of mobilization, weight-bearing, and unprotected weight-bearing as tolerated on postoperative recovery was compared using the Olerud Molander score, return to work/daily activities, and the rate of complications.
  
  
  RESULTS
  A total of 25 articles were included. Ankle exercises resulted in earlier return to work and/or daily activities compared to immobilization (mean difference (MD) -20.76 days; 95% confidence interval (CI) -40.02 to -1.50). There was no difference in the rate of complications between exercises and immobilization (risk ratio (RR) 1.22; 95% CI 0.60 to 2.45) or between early and late weight-bearing (RR 1.26; 95%CI 0.56 to 2.85).
  
  
  CONCLUSIONS
  Results of this meta-analysis show that following ankle surgery, 1) active exercises accelerate return to work and daily activities compared to immobilization, 2) early weight-bearing tends to accelerate return to work and daily activities compared to late weight-bearing. Active exercises in combination with immediate weight-bearing may be a safe option.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Diederik P J
authors.initials: DP
authors.lastname: Smeeing
authors.affiliation: Traumacenter University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Roderick M
authors.initials: RM
authors.lastname: Houwert
authors.affiliation: Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: Briet
authors.affiliation: Department of Epidemiology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Kelder
authors.affiliation: Department of Surgery, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
authors.forename: Michiel J M
authors.initials: MJ
authors.lastname: Segers
authors.affiliation: Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
authors.forename: Egbert Jan M M
authors.initials: EJ
authors.lastname: Verleisdonk
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Luke P H
authors.initials: LP
authors.lastname: Leenen
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Falco
authors.initials: F
authors.lastname: Hietbrink
mesh_terms: D064386:Ankle Fractures / Q000534:rehabilitation* / Q000601:surgery; D006801:Humans; D011184:Postoperative Period; D016032:Randomized Controlled Trials as Topic; D055070:Resistance Training; D012149:Restraint, Physical