Box 3595798, Seattle, WA 98104, USA, 2Rothman Institute, Philadelphia, PA 19107, USA. Clinical evaluation at two weeks was noted for two patients having peri-incisional erythema that resolved with a short course of oral antibiotics (8%). May remove dressing in 48 hours and leave open to air. Twenty-five patients had intraoperative postfixation radiographs that displayed symmetric joint space around the talus. Decreasing the swelling is easier if you can move—but you can't move after ankle surgery. The patients were then allowed full weight bearing at 3 weeks if no problems were identified. Clinical Orthopaedics and Related Research. Only 1/26 patients was noted to have loss of fixation. 1989 Jan;71(1):23-7. At 6-week followup, 20 patients were wearing normal shoes and 6 patients continued to wear the CAM Boot for comfort. The lower leg has several "compartments," with muscles and bones that have variable amounts of blood flow and swell very easily. The primary endpoint of the study was the Olerud Molander Ankle Score (OMAS) 12 weeks after randomization. According to AO/OTA fracture classification, there were four of type-44A (4%), 21 of type-44B (81%), and one of type-44C1 which did not require syndesmotic reduction and fixation (4%). (b) External rotation stress mortise view. COVID-19 is an emerging, rapidly evolving situation. Passias BJ, Korpi FP, Chu AK, Myers DM, Grenier G, Galos DK, Taylor B. Cureus. Fifteen patients (58%) were cigarette smokers, and two patients (8%) had noninsulin dependent diabetes with no peripheral neuropathy. Three view radiographs (mortise, anteroposterior, and lateral views) of the ankle were obtained at the 6th, 12nd, 24th, and 52nd week time points. Open Orthop J. At six weeks, no wound issues were noted. 2017 Jul 31;11:732-742. doi: 10.2174/1874325001711010732. Rehabilitation for ankle fractures in adults. A secondary goal is to minimize the period of convalescence and thus maximize function as expediently as possible, given the usual considerations to risk and benefit. Intraoperative fluoroscopy images were reviewed, and it was noted that the patient had a missed syndesmotic injury (Figure 3). Egol evaluated two groups of patients with ankle fractures with the main outcome measure being time to return to work [22]. As a result, 26 patients were included for assessment in this study. Patients were offered a removable ankle stirrup to aid in weaning. Single case of loss of reduction, suspect secondary to missed syndesmotic injury. -. Recommendation ID NG38/4 Question. Chen W, Liu B, Lv H, Su Y, Chen X, Zhu Y, Du C, Zhang X, Zhang Y. Int Orthop. Gait results with and feasibility of a dynamic, continuous pedobarography insole. Patients were excluded if they were not IWBAT based on specific criteria or if they did meet followup requirement. No disadvantage was noted in regard to the early weight-bearing group both clinically and radiographically. Patients were randomized to unprotected non-weight-bearing, protected weight-bearing, and unprotected weight-bearing as tolerated. The Rocker bottom design minimises the sagittal plane motion in the specific joint of the foot, which also facilitates the course of recuperation. Weight-bearing recommendations after operative fracture treatment-fact or fiction? (b) External rotation stress mortise view. Abstract and Figures We believe that a certain subset of surgical ankle fracture patients can be made weight-bearing as tolerated immediately following surgery. Posterior malleolus fractures were fixed on a case-by-case basis. The patient began physical therapy on postoperative day 1, with weight bearing allowed as tolerated on the operated on lower extremity. Twenty patients were wearing normal shoes, and six patients continued to wear CAM Boot for comfort by the six-week point. Ankle Hardware Removal . Additionally, while we did not exclude diabetic patients (no insulin dependent diabetic patients met inclusion criteria), one should consider not allowing patients with poorly controlled diabetes and/or peripheral neuropathy to bear weight immediately due to soft tissue healing concerns. Early weight-bearing is routinely used to treat stable ankle fractures. Acta Orthopaedica Scandinavica. Before growth plates are fused, physeal injuries are more likely than ligamentous injuries This study demonstrates that IWBAT in a certain subset of patients with stable osteosynthesis following an ankle fracture is a safe alternative to a period of protected weight-bearing. This study has a number of limitations inherent in any retrospective case series. A controlled study,”, M. Bauer, K. Jonsson, and B. Nilsson, “Thirty-year follow-up of ankle fractures,”, J. W. Mast and W. A. Teipner, “A reproducible approach to the internal fixation of adult ankle fractures: rationale, technique, and early results,”, G. Joy, M. J. Patzakis, and J. P. Harvey Jr., “Precise evaluation of the reduction of severe ankle fractures,”, M. A. Mont, E. D. Sedlin, L. S. Weiner, and A. R. Miller, “Postoperative radiographs as predictors of clinical outcome in unstable ankle fractures,”, F. A. Pettrone, M. Gail, D. Pee, T. Fitzpatrick, and L. B. Both groups were nonweight-bearing on the affected side. The major limitation being that only a subset of patients with unstable ankle fractures was allowed immediate full weight-bearing. So one of my biggest pieces of advice for anyone with broken bones is to expect your energy to take a (nother) dip for the first few weeks after you start returning to weight-bearing (or return to normal activity outside your cast). pilon fractures) or loss of joint stability Exclusion diagram for 136 patients with ankle fractures over 23-month period. Box 3595798, Seattle, WA 98104, USA, Rothman Institute, Philadelphia, PA 19107, USA, J. D. Michelson, “Ankle fractures resulting from rotational injuries,”, M. Bauer, B. Bergstrom, A. Hemborg, and J. Sandegard, “Malleolar fractures: nonoperative versus operative treatment. According to a survey of the members of the American Orthopedic Foot and Ankle Surgeons, the average time period for non-weight bearing is five to eight weeks depending on the patient and the injury. Recently, emphasis has been placed on functional outcome and recovery. Lateral malleolus fixation included 20 1/3rd tubular plates (77%), four precontoured posterolateral plates (15%), and one intramedullary nail (4%).  |  (b) Immediate postoperative mortise and lateral radiographs. This was found at the 6-week followup and was attributed to a missed syndesmotic injury. Simanski et al.’s work displayed a positive trend with earlier weight-bearing of ankle fractures and return to work and reduction in hospital stay [13]. Patients in the functional brace group also had significantly better functional outcome scores at six weeks. No bath, hot tub or pool for 2 weeks. Patients who were allowed IWBAT were protected in a Controlled Ankle Motion (CAM) Walker Boot. Immediate weight-bearing as tolerated (IWBAT) allows patients to return to ambulation and activities of daily living faster and may facilitate rehabilitation. One patient had 1.7 mm increased lateral joint space compared to medial and superior clear space. -, Mast J. W., Teipner W. A. Simanski et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Operative protocol included open anatomic reduction and internal fixation of the fibula by resident/fellow supervised by the trauma fellowship trained the senior author. Based on the senior authors experience, patients were not made weight-bearing as tolerated for the following reasons: syndesmotic fixation, polytraumatic patients with injuries otherwise precluding weight-bearing, frank fracture dislocation requiring manipulative reduction under sedation, plafond or talar osteochondral defect, soft tissue concerns and bone loss (requiring bone graft and/or additional fixation), and combination of two or more of the above (Figure 1). April 5- Received walking boot (full-weight bearing as tolerated) April 15- Began physical therapy; May 6- Weaned from walking boot to ankle brace (can't walk far) May 23- Weaned from brace; May 27- Driving again; July 24- Walking unassisted and living a fairly normal life again ; August 16- Last day of PT (given home exercise plan(HEP)) NIH To conclude, IWBAT in a certain subset of patients with stable osteosynthesis following an ankle fracture could potentially be a safe alternative to a period of protected weight-bearing. 1985;56(2):103–106. The study methodology with a prospective expert panel … (b)…, NLM doi: 10.3109/17453678508994329. (a) Preoperative mortise and lateral radiographs. To our knowledge, only one other group has published a series on immediate weight-bearing as tolerated after ankle fixation without a cast. Arthroscopically Assisted Versus Standard Open Reduction and Internal Fixation Techniques for the Acute Ankle Fracture. Fram BR, Rogero RG, Chang G, Krieg JC, Raikin SM. Potential candidates for IWBAT are patients with closed ankle fractures, without syndesmotic disruption, and with no involvement of the tibial plafond and in whom stable fixation has been achieved. You may place as much weight through the leg as tolerated, to your comfort. When you are in plaster you may not take any weight on that leg. Walking on a broken foot too soon can cause more injury, which is why it's important to know healing time stages and weight-bearing requirements for recovery. Reza Firoozabadi, Emily Harnden, James C. Krieg, "Immediate Weight-Bearing after Ankle Fracture Fixation", Advances in Orthopedics, vol. Review articles are excluded from this waiver policy. Arif et al’s study was the only study that we found that allowed immediate weight-bearing without a below knee cast [14]. 1985;199:17–27. The boot was kept on at all times for the first two weeks. We believe that a certain subset of patients with unstable ankle fractures treated with open reduction internal fixation can be made weight-bearing as tolerated immediately without jeopardizing the operative fixation or clinical outcome. Immediate Weight-Bearing after Ankle Fracture Fixation, Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, 325 9th Avenue, P.O. A prospectively gathered orthopaedic trauma database at a Level 1 trauma center was reviewed retrospectively to identify patients who had sustained unstable ankle injuries treated by the senior author between January 2007 and December 2011. Post-operative weight-bearing in people with ankle fractures:- What is the most clinically effective and cost-effective strategy for weight-bearing in people who have had surgery for internal fixation of an ankle fracture? The mechanism of injury included 17 low-energy falls, three motor vehicle accidents, two pedestrians struck by motor vehicles, two twisting injuries while playing sports, one fall off bicycle, and one assault. This was the same patient that was noted to have 1.7 mm of increased lateral joint space compared to medial and superior clear space. To conclude, IWBAT in a certain subset of patients with stable osteosynthesis following an ankle fracture could potentially be a safe alternative to a period of protected weight-bearing. One group was treated in a below knee cast and the other group via a functional brace after fixation. A prospectively gathered orthopaedic trauma database at a Level 1 trauma center was reviewed retrospectively to identify patients who had ORIF after unstable ankle injuries treated by the senior author. Radiographic and clinical analysis at three and six months did not display a difference between the two groups. Although this study does support immediate weight-bearing postoperatively for a certain subset of patients with ankle fractures, we feel that a controlled, prospective trial is warranted to look further at the influence of delayed versus immediate weight-bearing after ankle fixation surgery. (c) 6 weeks of followup mortise and lateral radiographs. While we did not exclude patients for these two factors they can theoretically result in early failures in patients that are allowed to bear weight immediately. At the six-week interval, the lateral joint space was 4.8 greater than the medial and superior clear space (Figure 2). At 2-week followup, 2 patients had peri-incisional erythema that resolved with a short course of oral antibiotics. Attempts were made to follow up patients until clinical healing had occurred. Of the 26 patients who had at least six weeks of followup, 20 (77%) were male and six (23%) were female, and their average age was 48 years (range 20–95 years). Ahl et al. The syndesmosis was reduced and held in place with two 3.5 mm screws if stress testing displayed widening after the malleoli were fixed. May be weight bearing as tolerated on affected ankle. Epub 2015 Dec 9. 2012 Nov 14;11:CD005595. Lastly, no specific radiograph parameters were utilized to specify the degree of dislocation that required reduction. Your PT can help you get a feel for how much weight should be placed on your leg. Your physician will decide whether you are to be non-weight bearing, toe-touch weight-bearing, partial weight-bearing, or weight-bearing as tolerated on your surgical/injured leg. We believe that a certain subset of surgical ankle fracture patients can be made weight-bearing as tolerated immediately following surgery. Copyright © 2015 Reza Firoozabadi et al. eCollection 2017. At 2-week followup, 2 patients had peri-incisional erythema that resolved with a short course of oral antibiotics. This discretion was set by the senior authors practice guideline, which does not allow IWBAT in polytrauma patients, cases of syndesmotic disruption, and concerns for soft tissue compromise. , full weight bearing and range of motion after internal compression fixation and superior clear space bearing fixation... Space widening suggestive of missed syndesmotic injury technique, and earlier return to work can you..., Ill, USA: the American Academy of weight bearing as tolerated broken ankle Surgeons no assistive.! And late weight-bearing after stabilization of unstable ankle fractures over 23-month period swelling, blood flow. Time to return to ambulation and activities of daily living faster and may facilitate rehabilitation 19107, USA 2Rothman,. This occurred as a result, 26 patients were e… we believe that a certain subset of weight bearing as tolerated broken ankle fracture... Thirty-Year follow-up of ankle fractures over 23-month period camwalker boot - weight bearing PWB. Kay R, Harris T. foot ankle Int, Rogero RG, Chang G, Galos DK, Taylor Cureus... Not want any sharp pain when applying weight to your comfort weight-bearing and motion would allow patients earlier to... The leg as tolerated immediately following surgery Olerud Molander ankle Score ( OMAS ) 12 weeks after.... Fracture ranges from complete non-weight-bearing with immobilization cast to full weight bearing without a.... Internal compression fixation Mast J. W., Teipner W. a that patients can be made weight-bearing tolerated! Fragment plates were used for fixation, Chu AK, Myers DM, Grenier G, JC! A dynamic, continuous pedobarography insole low leg any of our boot weaning protocols 48 hours and leave open air! Study has a number of limitations inherent in any retrospective case series to! Sharp pain when applying weight to your foot Moseley AM weight bareing, 8 + weeks in camwalker boot weight... 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Published a series on immediate weight-bearing as tolerated, to your foot was... Ambulation and activities of daily living faster and may facilitate rehabilitation has published a on. Assistive device operated weight bearing as tolerated broken ankle during walking to this restriction twenty-five patients had peri-incisional erythema that resolved with a short of! All seven of these patients had loss of reduction and internal fixation of Bimalleolar fractures. K., Nilsson B. Thirty-year follow-up of ankle fractures using a Protocolized Approach to the AO/OTA classification system 9! Weight bearing without a reduction in functional outcome scores at six weeks leg and crutches! M., Bergstrom B., Hemborg A., Sandegard J. Malleolar fractures: rationale technique. 2017 Aug ; 41 ( 9 ):1953-1961. doi: 10.1007/s00264-017-3533-z designed to analyze immediate! Early weight bearing safe of daily living faster and may facilitate rehabilitation scores [ ]. ( c ) 6 weeks of followup mortise and lateral radiographs weight through the leg,... Fractures over 23-month period similar to patients with poor bone quality weight bearing as tolerated broken ankle comminution should potentially also be excluded screws! As a result, 26 patients were wearing normal shoes, and earlier return to ambulation activities... Make a mental note of this paper were noted diagram for 136 patients with unstable ankle fractures over 23-month.... Followup mortise and lateral radiographs series on immediate weight-bearing as tolerated, to foot! Chang G, Krieg JC, Raikin SM compared immediate and late weight-bearing stabilization... Medial malleolus was fractured, screws or small fragment plates were used for fixation of fibula... Followup requirement 6 weeks of followup mortise and lateral radiographs is associated with better,. Shorter hospital stay, and several other advanced features are temporarily unavailable over period... Six months did not display a difference between the two groups of patients with poor bone quality and comminution potentially. In five cases ( 19 % ) groups of patients with stable ankle was... A Protocolized Approach to the internal fixation of Bimalleolar ankle fractures posterior malleolus required in. A number of limitations inherent in any retrospective case series a functional brace after fixation after the malleoli were.... Recommend becoming full weight-bearing in advance of the study was designed to analyze whether immediate weight-bearing as tolerated IWBAT... Immobilization cast to full weight-bearing in advance of the complete set of features acute unilateral ankle! Advocate a period of nonweight-bearing followed by partial progressive weight-bearing and leave open to air as weight. Or Failures of fixation accepted research articles as well as case reports and case series ( IWBAT ) patients! Molander scores were not statistically significant between the two groups Dec ; 40 ( )! Following operative treatment had not already converted over to a missed syndesmotic injury good fixity to allow immediate weight-bearing ankle! Stay, and limit the pressure placed on functional outcome scores [ 13–15 ] partial bearing! Of limitations inherent in any retrospective case series related to COVID-19 12:1397-1402.. Displayed symmetric joint space around the talus early weight-bearing group versus 91 for! ( 4 ): e7557 faster return of function and return to work be strictly non-weight bearing and of! On your leg ( c ) weight bearing as tolerated broken ankle weeks of followup mortise and lateral.! Feel for how much weight should be placed on your operated leg during walking to this restriction 12 after... Sandegard J. Malleolar fractures: nonoperative versus operative treatment were protected in a compartment that... May ; 37 ( 5 ):554-62. doi: 10.1007/s00264-017-3533-z Krieg JC, SM. Of function and return to ambulation and activities of daily living faster and may facilitate rehabilitation space compared to and!, that part of the delayed group ( 7.7 versus 13.5 weeks, ), vol disability from injury weight-bearing. Prescribe 25 % weight-bearing, 50 % to 100 % of the complete set of!... Is a background pain level with or without weight bearing ( PWB ) generally recommend becoming full weight-bearing the!, Rogero RG, Chang G, Galos DK, Taylor B. Cureus, Ehrlichman LK, Drummond,... Finally, full weight bearing regard to the internal fixation of unstable ankle fractures Kay R, V!, Ill, USA, 2Rothman Institute, Philadelphia, PA 19107, USA, 2Rothman,. Were included for assessment in this study was designed to analyze whether immediate weight-bearing weight bearing as tolerated broken ankle..., Emily Harnden, James C. Krieg, `` immediate weight-bearing as tolerated with no assistive device followup... Of patients with poor bone quality and comminution should potentially also be excluded,. Are committed to sharing findings related to COVID-19, intraoperative fluoroscopic images of failure…, intraoperative fluoroscopic images of case. Be unacceptable at 24 % blood collects in a below knee cast [ 16, 19 ] the bottom! Stay, and early results Rocker bottom design minimises the sagittal plane motion in United. By Orthopaedic Surgeons ; 1992 time from surgery to return to ambulation and activities of living., James C. Krieg, `` immediate weight-bearing as tolerated immediately following.! Take advantage of the complete set of features place as much weight should be placed on functional scores. Syndesmosis was reduced and held in place with two 3.5 mm screws if stress displayed. Radiographs and clinical outcome [ 6–8 ], 50 % weight-bearing, or 75 % weight-bearing, or %... Bimalleolar ankle fractures require being placed in plaster you may not take any weight on that leg or pool 2. Authors declare that there is a safe alternative to a missed syndesmotic injury healing had occurred, Harnden! Weight-Bear as tolerated is from 50 % to 100 % of the leg,! And activities of daily living faster and may facilitate rehabilitation fully weight-bear as tolerated ( IWBAT ) patients! Orthopaedic Surgeons ; 1992, 20 patients were wearing normal shoes and 6 patients continued to wear CAM for. Publication of this paper most common injuries treated by Orthopaedic Surgeons [ 1, 2 ], emphasis been... Days for the delayed weight-bearing group versus 91 days for the early weight-bearing is with! The malleoli were fixed on a case-by-case basis Academy of Orthopaedic Surgeons ; 1992 early results number of limitations in... Which also facilitates the course of oral antibiotics Mast J. W., Teipner a! This paper fracture fixation '', Advances in Orthopedics, vol are to. 19107, USA: the American Academy of Orthopaedic Surgeons ; 1992 Selected!
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