Early Weightbearing Following Surgical Treatment of Ankle Fractures without Trans-Syndesmotic Fixation is Safe and Improves Short Term Outcomes

Abstract

OBJECTIVES: To ascertain outcome differences after fixation of unstable rotational ankle fractures allowed to weight bear two weeks postoperatively compared to six weeks. METHODS: Design: Prospective Case-Control Study Setting: Academic medical center; Level 1 trauma center Patient Selection Criteria: Patients with unstable ankle fractures (OTA:44A-C) undergoing ORIF were enrolled. Patients requiring trans-syndesmotic fixation were excluded. Two surgeons allowed weightbearing at two weeks postoperatively (early weightbearing group (EWB)). Two other surgeons instructed standard non-weightbearing until six weeks postoperatively (NWB group). Main Outcome Measures and Comparisons: Outcomes included Olerud-Molander, SF-36, and Visual Analog Scale (VAS) at six-weeks, three-months, six-months, 12-months postoperatively, and complications, return to work, range of ankle motion, and reoperations at 12-months. RESULTS: 107 patients were included. The two cohorts did not differ in demographics or pre-injury scores (p>0.05). Six weeks postoperatively EWB patients had improved functional outcomes as measured by the Olerud-Molander and SF-36 questionnaires. Early weightbearing patients also had better VAS scores (Standardized Mean Difference (SMD) -0.98, 95% Confidence Interval (CI) -1.27 to -0.70, p<0.05) and a greater proportion returning to full capacity work at six weeks (Odds Ratio (OR) = 3.42, 95%CI 1.08 to 13.07, p<0.05). One year postoperatively, EWB had improved pain measured by SF-36 (SMD 6.25, 95%CI 5.59 to 6.92, p<0.01) and VAS scores (SMD -0.05, 95%CI -0.32 to 0.23, p<0.01). There were no differences in complications or reoperation at 12 months (p>0.05). Conclusions: EWB patients had improved early function, final pain scores, earlier return to work, without an increased complication rate compared to those kept NWB for six weeks.