title: Early Weightbearing and Range of Motion Versus Non-Weightbearing and Immobilization After Open Reduction and Internal Fixation of Unstable Ankle Fractures: A Randomized Controlled Trial.
abstract: OBJECTIVE
  The aim of this study was to compare early weightbearing and range of motion (ROM) to nonweightbearing and immobilization in a cast after surgical fixation of unstable ankle fractures.
  
  
  METHODS
  Multicentre randomized controlled trial.
  
  
  METHODS
  Two-level one trauma centers.
  
  
  METHODS
  One hundred ten patients who underwent open reduction and internal fixation of an unstable ankle fracture were recruited and randomized.
  
  
  METHODS
  One of 2 rehabilitation protocols: (1) Early weightbearing (weightbearing and ROM at 2 weeks, Early WB) or (2) Late weightbearing (nonweightbearing and cast immobilization for 6 weeks, Late WB).
  
  
  METHODS
  The primary outcome measure was time to return to work (RTW). Secondary outcome measures included: ankle ROM, SF-36 heath outcome scores, Olerud/Molander ankle function score, and rates of complications.
  
  
  RESULTS
  There was no difference in RTW. At 6 weeks postoperatively, patients in the Early WB group had significantly improved ankle ROM (41 vs. 29, P < 0.0001); Olerud/Molander ankle function scores (45 vs. 32, P = 0.0007), and SF-36 scores on both the physical (51 vs. 42, P = 0.008) and mental (66 vs. 54, P = 0.0008) components. There were no differences with regard to wound complications or infections and no cases of fixation failure or loss of reduction. Patients in the Late WB group had higher rates of planned/performed hardware removal due to plate irritation (19% vs. 2%, P = 0.005).
  
  
  CONCLUSIONS
  Given the convenience for the patient, early improved functional outcome, and the lack of an increased complication rate, we recommend early postoperative weightbearing and ROM in patients with surgically treated ankle fractures.
  
  
  METHODS
  Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedics, Li Ka Shing Institute, St. Michael's Hospital and the University of Toronto, Toronto, Canada; †Division of Orthopaedics, Department of Surgery, St. Michael's Hospital and the University of Toronto, Toronto, Canada; ‡Division of Orthopaedics, Department of Surgery, Sunnybrook Health Science Centre and the University of Toronto, Toronto, Canada; §Department of Surgery, Western University, London, Canada; ‖Department of Surgery, St. Vincent Medical Center, Portland, OR; ¶Division of Orthopaedics, Department of Surgery, Sunnybrook Health Science Centre and the University of Toronto, Toronto, Canada; and **Division of Orthopaedics, Department of Surgery, Sunnybrook Health Science Centre and the University of Toronto, Toronto, Canada.
authors.forename: Niloofar
authors.initials: N
authors.lastname: Dehghan
authors.forename: Michael D
authors.initials: MD
authors.lastname: McKee
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Jenkinson
authors.forename: Emil H
authors.initials: EH
authors.lastname: Schemitsch
authors.forename: Venessa
authors.initials: V
authors.lastname: Stas
authors.forename: Aaron
authors.initials: A
authors.lastname: Nauth
authors.forename: Jeremy A
authors.initials: JA
authors.lastname: Hall
authors.forename: David J
authors.initials: DJ
authors.lastname: Stephen
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Kreder
mesh_terms: D000328:Adult; D064386:Ankle Fractures / Q000175:diagnosis / Q000534:rehabilitation* / Q000601:surgery; D001860:Bone Plates; D002370:Casts, Surgical; D016009:Chi-Square Distribution; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods* / Q000534:rehabilitation; D006801:Humans; D007103:Immobilization / Q000379:methods*; D015601:Injury Severity Score; D007593:Joint Instability / Q000175:diagnosis / Q000534:rehabilitation / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011182:Postoperative Care / Q000379:methods; D016059:Range of Motion, Articular; D020127:Recovery of Function; D062707:Return to Work; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D016474:Weight-Bearing