title: How long should patients be kept non-weight bearing after ankle fracture fixation? A survey of OTA and AOFAS members.
abstract: BACKGROUND
  Ankle fractures are common injuries treated routinely by orthopaedic surgeons. A variety of different post-operative protocols have been described with differing periods of non-weight bearing after surgery. The aim of this study was to identify how patient injury characteristics and medical comorbidities contribute to the period of non-weight bearing chosen by orthopaedic surgeons after open reduction and internal fixation of rotational ankle fractures.
  
  
  METHODS
  A cross sectional expert opinion survey was administered to members of the AOFAS as well as OTA to determine how long they would instruct patients to be non-weight bearing after open reduction and internal fixation of ankle fractures. Three different injury characteristics were described: supination external rotation type 4 equivalents, bimalleolar, and trimalleolar patterns. These patterns were combined with three different medical statuses: young and healthy, older and healthy, and older with significant medical comorbidity. Respondents selected how long they would keep the patient non-weight bearing after surgery for each of the potential scenarios. Finally, they were directly asked which factors they felt affected their decision about length of time to keep patients non-weight bearing.
  
  
  RESULTS
  Seven hundred and two surgeons (31%) responded to the survey. The average time of non-weight bearing selected varied from 4.9 (± 3.1) weeks for in young, healthy patients with SER4 equivalent injuries to 7.6 (± 6.0) weeks for older patients with medical comorbidities with trimalleolar fractures. Responses had a high degree of heterogeneity, but both injury pattern and medical status were significant predictors of non-weight bearing period (p<0.01), with medical status the stronger determinant.
  
  
  CONCLUSIONS
  There is significant variation among orthopaedic surgeons when selecting period of non-weight bearing after fixation of ankle fractures, with both injury pattern and medical comorbidity playing a role in decision of time to keep patient non-weight bearing. Further research further evaluating the relationship between these factors and safe periods of non-weight bearing could help identify patients that may benefit from earlier mobilization, and improve surgeon's comfort with early mobilization.
  
  
  METHODS
  Therapeutic Level V.
authors: Columbia University Medical Center, 622 West 168th Street, PH-1130, New York, NY 10032, United States. Electronic address: ericswartmd@gmail.com.
authors: Eric
authors: E
authors: Swart
authors: Columbia University Medical Center, 622 West 168th Street, PH-1130, New York, NY 10032, United States.
authors: Hariklia
authors: H
authors: Bezhani
authors: Columbia University Medical Center, 622 West 168th Street, PH-1130, New York, NY 10032, United States.
authors: Justin
authors: J
authors: Greisberg
authors: Columbia University Medical Center, 622 West 168th Street, PH-1130, New York, NY 10032, United States.
authors: J Turner
authors: JT
authors: Vosseller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000601:surgery*; D000843:Ankle Joint / Q000503:physiopathology* / Q000601:surgery; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome; D016474:Weight-Bearing
keywords: Ankle fracture; Non-weight bearing