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(a) Preoperative mortise and lateral radiographs. Decreasing the swelling is easier if you can move—but you can't move after ankle surgery. Study: Weight Bearing OK After ORIF for Ankle Fracture A study to be presented today found that for patients who underwent open reduction and internal fixation (ORIF) for an ankle fracture, weight bearing as tolerated (WBAT) was safe, regardless of the fracture pattern. This study was approved by our institutional review board. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. One patient had 1.7 mm increased lateral joint space compared to medial and superior clear space. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. At 6-week postoperation, the boot was discontinued if the patient had not already converted over to a shoe. Single case of loss of reduction, suspect secondary to missed syndesmotic injury. Radiographic evaluation at six weeks displayed no loss of reduction in 25 patients (96%) and one loss of reduction (4%). This was found at the 6-week followup and was attributed to a missed syndesmotic injury. Numerous authors have shown an association between postoperative radiographs and clinical outcome [6–8]. Postoperative care after an ankle fracture ranges from complete non-weight-bearing with immobilization cast to full weight-bearing as tolerated with no protective equipment. This study shows that unprotected weight-bearing as tolerated is a safe postoperative care regimen in adult patients with a supination external rotation type2–4 ankle fracture who have no comorbidities. Patients were excluded if they were not IWBAT based on specific criteria or if they did meet followup requirement. Fram BR, Rogero RG, Chang G, Krieg JC, Raikin SM. Earlier weight-bearing has been associated with better mobility, shorter hospital stay, and earlier return to work. If all seven of these patients had loss of reduction then the failure rate would be unacceptable at 24%. We will be providing unlimited waivers of publication charges for accepted research articles as well as case reports and case series related to COVID-19. Acta Orthopaedica Scandinavica. At 6-week followup, 20 patients were wearing normal shoes and 6 patients continued to wear the CAM Boot for comfort. Finsen V, Saetermo R, Kibsgaard L, Farran K, Engebretsen L, Bolz KD, Benum P. Early postoperative weight-bearing and muscle activity in patients who have a fracture of the ankle. Recently, emphasis has been placed on functional outcome and recovery. Park City, Ill, USA: The American Academy of Orthopaedic Surgeons; 1992. Ankle fractures are among the most common injuries treated by orthopaedic surgeons [1, 2]. In line with NICE (The National Institute for Health and Care Excellence) criteria, “early” weight-bearing was defined as unrestricted weight-bearing on the affected leg within 3 weeks of injury or surgery and “delayed” weight-bearing as unrestricted weight-bearing permitted after 3 weeks. (a) Preexternal rotation stress mortise view. 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. Lastly, no specific radiograph parameters were utilized to specify the degree of dislocation that required reduction. Weight-bearing as tolerated and formal ankle range of motion therapy starting at 2 weeks The primary outcome in this study was time to return to work, and secondary outcomes included ankle range of motion, functional and health outcome scores and complication rates. USA.gov. Epub 2019 Aug 8. Keep ankle elevated and dry. Weight Bearing As Tolerated (WBAT): There is no limitation on the amount of weight you can place through the surgical/injured leg. Single case of loss of reduction, suspect secondary to missed syndesmotic injury. At two weeks, the dressings were removed and the wound assessed. This was found at the 6-week followup and was attributed to a missed syndesmotic injury. 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. (a)…, Intraoperative fluoroscopic images of failure…, Intraoperative fluoroscopic images of failure case. 2020 Nov 9. doi: 10.1097/BOT.0000000000002003. May shower and get ankle wet. 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]. Following operative treatment of ankle fractures, most physicians advocate a period of nonweight-bearing followed by partial progressive weight-bearing. The authors declare that there is no conflict of interests regarding the publication of this paper. These instructions are specifically for patients that are partial weight bearing (PWB). Furthermore studies have shown reduced calf atrophy and decreased osteoporotic changes with earlier weight-bearing [20, 21]. Radiological study of the secondary reduction effect of early functional exercise on displaced intra-articular calcaneal fractures after internal compression 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. 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. Lin CW, Donkers NA, Refshauge KM, Beckenkamp PR, Khera K, Moseley AM. Move ankle as much as possible. 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. Weight bearing as tolerated is from 50% to 100% of the body weight on the healing leg. The above stated studies all suggest that earlier weight-bearing and motion would allow patients earlier return to function without any compelling disadvantage. You will be given 4 medications: Patients were e… We believe that a certain subset of surgical ankle fracture patients can be made weight-bearing as tolerated immediately following surgery. No disadvantage was noted in regard to the early weight-bearing group both clinically and radiographically. (b) External rotation stress mortise view. Clinical Orthopaedics and Related Research. Immediate weight-bearing as tolerated (IWBAT) allows patients to return to ambulation and activities of daily living faster and may facilitate rehabilitation. 1980;11(3):661–679. In cases in which the medial malleolus was fractured, screws or small fragment plates were used for fixation. Epub 2017 Apr 19. The sutures were removed and replaced with Steri-Strips. The syndesmosis was reduced and held in place with two 3.5 mm screws if stress testing displayed widening after the malleoli were fixed. (b)…, NLM Ahl et al. -, Bauer M., Jonsson K., Nilsson B. Thirty-year follow-up of ankle fractures. Safety of Early Weight Bearing Following Fixation of Bimalleolar Ankle Fractures. Purpose: The goal of this study was to assess if unprotected weight-bearing as tolerated is superior to protected weight-bearing and unprotected non-weight-bearing in terms of functional outcome and complications after surgical fixation of Lauge-Hansen supination external rotation stage 2-4 ankle fractures. Braun BJ, Veith NT, Rollmann M, Orth M, Fritz T, Herath SC, Holstein JH, Pohlemann T. Int Orthop. (a) Preexternal rotation stress mortise view. Postoperative protocols were similar to all patients. When starting weight bearing, it's okay if there is a slight increase in pain while weight bearing and a moderate increase in background pain for a couple of days afterwards. The patients were then instructed to continue wearing the CAM Walker Boot for an additional 2–4 weeks, coming out for hygiene only and to wean out of the boot by 6 weeks. 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. When blood collects in a compartment, that part of the leg swells, making it a challenge to recover. A prospective, randomised comparison of management in a cast or a functional brace,”, M. P. Starkweather, D. R. Collman, and J. M. Schuberth, “Early protected weightbearing after open reduction internal fixation of ankle fractures,”. May remove dressing in 48 hours and leave open to air. Your PT can help you get a feel for how much weight should be placed on your leg. Review articles are excluded from this waiver policy. 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. 2017 Jul 31;11:732-742. doi: 10.2174/1874325001711010732. Early weight-bearing patients were able to obtain full weight-bearing in advance of the delayed group (7.7 versus 13.5 weeks, ). This study concluded that, in certain ankle fracture patients, immediate weight-bearing as tolerated is “a safe alternative to a period of protected weight-bearing”, such as a cast.  |  Patients were randomized to unprotected non-weight-bearing, protected weight-bearing, and unprotected weight-bearing as tolerated. Earlier weight-bearing is associated with earlier return to full weight bearing without a reduction in functional outcome scores [13–15]. Epub 2015 Dec 9. 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). Patients had a complete medical history and physical exam performed either in the emergency department or in clinic by an orthopaedic surgery resident/fellow under the guidance of an attending. (a) Preoperative mortise and lateral radiographs. 2020 Apr 6;12(4):e7557. When you are in plaster you may not take any weight on that leg. -. To our knowledge, only one other group has published a series on immediate weight-bearing as tolerated after ankle fixation without a cast. Exclusion diagram for 136 patients with ankle fractures over 23-month period. Praemer A., Furner S., Rice D. P. Musculoskeletal Conditions in the United States. doi: 10.7759/cureus.7557. Fractures were classified according to the AO/OTA classification system [9]. Posterior malleolus required fixation in five cases (19%). Chen W, Liu B, Lv H, Su Y, Chen X, Zhu Y, Du C, Zhang X, Zhang Y. Int Orthop. ankle surgery, of which were allowed immediate weight-bearing as tolerated (IWBAT) in the acute postoperative period. May be weight bearing as tolerated on affected ankle. Cochrane Database Syst Rev. The study methodology with a prospective expert panel … 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. 2019 Dec;40(12):1397-1402. doi: 10.1177/1071100719867932. Michelson J. D. Ankle fractures resulting from rotational injuries. 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. 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. The patients were then allowed full weight bearing at 3 weeks if no problems were identified. Weight-bearing recommendations after operative fracture treatment-fact or fiction? Online ahead of print. Immediate Weight-Bearing after Ankle Fracture Fixation, Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, 325 9th Avenue, P.O. Foot Ankle Int. Sign up here as a reviewer to help fast-track new submissions. Based on the senior authors experience, patients were not made weight-bearing as tolerated for the following reasons: syndesmotic xation, polytraumatic patients with injuries otherwise precluding weight-bearing, frank fracture No bath, hot tub or pool for 2 weeks. Our patient group had one case of loss of reduction and fixation failure. It facilitates rehabilitation and allows the patient to have better mobility [15–19]. Twenty-five patients had intraoperative postfixation radiographs that displayed symmetric joint space around the talus. Finally, full weight bearing is 100% of the body weight on the healing leg with no assistive device. 2015, Article ID 491976, 6 pages, 2015. https://doi.org/10.1155/2015/491976, 1Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, 325 9th Avenue, P.O. At 2-week followup, 2 patients had peri-incisional erythema that resolved with a short course of oral antibiotics. 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. 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. Return to work was 55 days for the early weight-bearing group versus 91 days for the delayed weight-bearing group, which was statistically significant. Patients with poor bone quality and comminution should potentially also be excluded. Pyle C, Kim-Orden M, Hughes T, Schneiderman B, Kay R, Harris T. Foot Ankle Int. Clipboard, Search History, and several other advanced features are temporarily unavailable. Medial clear space widening suggestive of missed syndesmotic injury. Operative protocol included open anatomic reduction and internal fixation of the fibula by resident/fellow supervised by the trauma fellowship trained the senior author. Make a mental note of this, and limit the pressure placed on your operated leg during walking to this restriction. At 2-week followup, 2 patients had peri-incisional erythema that resolved with a short course of oral antibiotics. This study has a number of limitations inherent in any retrospective case series. 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. doi: 10.3109/17453678508994329. Immediate weight-bearing as tolerated (IWBAT) allows patients to return to ambulation and activities of daily living faster and may facilitate rehabilitation. 2016 May;37(5):554-62. doi: 10.1177/1071100715620455. Bauer M., Bergstrom B., Hemborg A., Sandegard J. Malleolar fractures: nonoperative versus operative treatment. Recommendation ID NG38/4 Question.  |  Another limitation of this study is that we did not have a control group and seven patients did not have appropriate followup and therefore excluded. 2 weeks no weight bareing, 8 + weeks in camwalker boot - weight bearing as tolerated. The primary goals of fracture surgery and postoperative regimen are to minimize disability from injury. HHS This occurred as a result of a missed syndesmotic injury. See this image and copyright information in PMC. Immediate weight-bearing as tolerated (IWBAT) allows patients to return to ambulation and activities of daily living faster and may facilitate rehabilitation. Early weight-bearing is routinely used to treat stable ankle fractures. Only 1/26 patients was noted to have loss of fixation. 1985;199:17–27. 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. Do not submerge ankle for 2 weeks. Please enable it to take advantage of the complete set of features! Placing weight through the leg is important for preventing the … Reza Firoozabadi, Emily Harnden, James C. Krieg, "Immediate Weight-Bearing after Ankle Fracture Fixation", Advances in Orthopedics, vol. A controlled study. We assume that earlier weight-bearing will allow patients to return to their activities of daily living quicker, with an overall easier time during convalescence. 2012 Nov 14;11:CD005595. At the six-week interval, the lateral joint space was 4.8 greater than the medial and superior clear space (Figure 2). 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. Patients were instructed to keep the wound dry until seen at the two-week clinic followup. A reproducible approach to the internal fixation of adult ankle fractures: rationale, technique, and early results. performed a prospective study comparing functional early weight bearing (3 weeks) to 6 weeks without weight-bearing in a below knee cast [13]. 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 …  |  Olerud and Molander scores were not statistically significant between the groups. Patients in the functional brace group also had significantly better functional outcome scores at six weeks. Our findings show that patients can fully weight-bear as tolerated during the immediate postoperative period similar to patients with stable ankle fractures. They may prescribe 25% weight-bearing, 50% weight-bearing, or 75% weight-bearing. Three view radiographs (mortise, anteroposterior, and lateral views) of the ankle were obtained at the 6th, 12nd, 24th, and 52nd week time points. 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. 2017 Aug;41(8):1507-1512. doi: 10.1007/s00264-017-3481-7. Early functional results after osteosynthesis of ankle joint fractures,”, K. A. Egol, R. Dolan, and K. J. Koval, “Functional outcome of surgery for fractures of the ankle. 38 years experience Orthopedic Foot and Ankle Surgery With doc's ok: If your doctor has ok'ed you to start putting weight on it without the need for a brace, it is "progressive weight bearing as … 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). Passias BJ, Korpi FP, Chu AK, Myers DM, Grenier G, Galos DK, Taylor B. Cureus. We generally recommend becoming full weight-bearing in the boot prior to any of our boot weaning protocols. To reduce swelling, blood must flow toward the heart—or "upstream" from the low leg. Fifteen patients (58%) were cigarette smokers, and two patients (8%) had noninsulin dependent diabetes with no peripheral neuropathy. We believe that a certain subset of surgical ankle fracture patients can be made weight-bearing as tolerated immediately following surgery. You are fighting against gravity. At 6-week followup, 20 patients were wearing normal shoes and 6 patients continued to wear the CAM Boot for comfort. (b) External rotation stress mortise view. Ninety-nine percent of the radiographs showed no loss of reduction on final followup examination [23]. If your fracture is like mine, there is a background pain level with or without weight bearing. prospectively compared immediate and late weight-bearing after ankle fixation in a below knee cast [16, 19]. We are committed to sharing findings related to COVID-19 as quickly as possible. More recently, Starkweather et al. Intraoperative fluoroscopy images were reviewed, and it was noted that the patient had a missed syndesmotic injury (Figure 3). Simanski et al. Abstract and Figures We believe that a certain subset of surgical ankle fracture patients can be made weight-bearing as tolerated immediately following surgery. The lower leg has several "compartments," with muscles and bones that have variable amounts of blood flow and swell very easily. 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%). Short Term Complications in Geriatric Ankle Fractures Using a Protocolized Approach to Surgical Treatment: Is Early Weight Bearing Safe? Stable, non-displaced, isolated uni-malleolar fracture (without opposing ligament injury), can be splinted in short leg splint or boot (with ankle at 90 degrees) with early weight bearing as tolerated (Phillips 1985), Mehta 2014) Operative: Indications are loss of joint congruency (i.e. NIH 3-6 weeks -Weight bearing advancement and activity restrictions per MD/fracture type -Boot/cast per MD -Exercises and hands-on techniques (by the PT) for foot and ankle active and passive range of motion -Strengthening for core, hips, knees (maintain precautions) -Weight shifting with boot and assistive device (maintain precautions) eCollection 2017. 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. suffered broken ankle in May 2010. Intraoperative fluoroscopic images of failure case. doi: 10.1002/14651858.CD005595.pub3. Intraoperative fluoroscopic images of failure case. (b) Immediate postoperative mortise and lateral radiographs. 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? Radiographic and clinical analysis at three and six months did not display a difference between the two groups. retrospectively reviewed 126 patients who bore weight in a short leg cast within 15 days after surgical repair of acute unilateral closed ankle fractures. Although no clear indications exist for fixation of small posterior malleolus fractures, many of the small fractures and all of the larger fractures were treated operatively. (c) 6 weeks of followup mortise and lateral radiographs. 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)) Before growth plates are fused, physeal injuries are more likely than ligamentous injuries Posterior malleolus fractures were fixed on a case-by-case basis. Operative Treatment of Posterior Malleolar Fractures. et al., “Effects of immobilization on plantar-flexion torque, fatigue resistance, and functional ability following an ankle fracture,”, K. Sondenaa, U. Hoigaard, D. Smith, and A. Alho, “Immobilization of operated ankle fractures,”, T. Ahl, N. Dalen, A. Lundberg, and C. Bylund, “Early mobilization of operated on ankle fractures: prospective, controlled study of 40 bimalleolar cases,”, M. Järvinen and P. Kannus, “Injury of an extremity as a risk factor for the development of osteoporosis,”, U. Stöckle, B. König, A. Tempka, and N. P. Südkamp, “Cast immobilization versus vacuum stabilizing system. COVID-19 is an emerging, rapidly evolving situation. 2017 Sep;41(9):1953-1961. doi: 10.1007/s00264-017-3533-z. The boot was kept on at all times for the first two weeks. Twenty patients were wearing normal shoes, and six patients continued to wear CAM Boot for comfort by the six-week point. Box 3595798, Seattle, WA 98104, USA, 2Rothman Institute, Philadelphia, PA 19107, USA. Faster return of function and return to work are related to rehabilitation strategy. Open anatomic reduction and internal fixation are routinely advocated for displaced, unstable ankle fractures [3–5]. At six weeks, no wound issues were noted. Single case of loss of reduction, suspect secondary to missed syndesmotic injury. Orthopedic Clinics of North America. Patients who were allowed IWBAT were protected in a Controlled Ankle Motion (CAM) Walker Boot. A total of 136 skeletally mature patients underwent ankle surgery, 33 of which were allowed immediate weight-bearing as tolerated (IWBAT) in the acute postoperative period. J Orthop Trauma. Immediate Weight Bearing and Range of Motion After Internal Fixation of Selected Malleolar Fractures: A Retrospective Non-Inferiority Controlled Study. At the last clinic visit, three patients had persistent ankle stiffness, one patient had symptoms consistent with peroneal subluxation, which resolved with physical therapy, and one patient required removal of medial malleolar fixation secondary to symptomatic hardware. This means that you will be strictly non-weight bearing and hopping on the other leg and using crutches. Clinical evaluation at two weeks was noted for two patients having peri-incisional erythema that resolved with a short course of oral antibiotics (8%). Patients with ankle fractures will be instructed to weight bear as tolerated (WBAT) while in a boot with a heel to toe normal gait and wean from walker or crutches to a cane or no support device. (b) Immediate postoperative mortise and lateral radiographs. pilon fractures) or loss of joint stability Exclusion diagram for 136 patients with ankle fractures over 23-month period. We believe that a certain subset of surgical ankle fracture patients can be made weight-bearing as tolerated immediately following surgery. Egol evaluated two groups of patients with ankle fractures with the main outcome measure being time to return to work [22]. The Journal of the American Academy of Orthopaedic Surgeons. At the scheduled followup, patients had wound assessment, radiographic analysis of fracture reduction maintenance and healing, clinical fracture healing evaluation, and complications requiring further surgery. Generally, when patients are placing between 50 and 75% of the weight on the injured leg they are able to transition to using 1 crutch or cane on the opposite side. This site needs JavaScript to work properly. 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. Immediate weight-bearing as tolerated (IWBAT) allows patients to return to ambulation and activities of daily living faster and may facilitate rehabilitation. Time to return to work was not assessed. Ankle Hardware Removal . 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. Seven out of the 33 patients did not follow up past the two-week point, five patients received followup out of state, and two patients did not return to two-week clinic appointment. Bimalleolar, trimalleolar, fracture dislocation, and fibular fractures with more than 4 mm medial clear space widening on stress radiographs or positive gravity stress views were deemed unstable [10–12]. Patients were offered a removable ankle stirrup to aid in weaning. The major limitation being that only a subset of patients with unstable ankle fractures was allowed immediate full weight-bearing. (a) Preexternal rotation stress mortise view. (c) 6 weeks of followup mortise and lateral radiographs. 6-Week postoperation, the dressings were removed and the wound assessed fractured, screws or small plates. Your weight-bearing instructions in order to avoid disrupting the healing process this paper, the lateral joint space compared medial!, Seattle, WA 98104, USA, 2Rothman Institute, Philadelphia, PA 19107,:!, Bergstrom B., Hemborg A., Sandegard J. Malleolar fractures: rationale, technique, and six patients to... ; 41 ( 9 ):1953-1961. doi: 10.1007/s00264-017-3533-z and weight bearing as tolerated broken ankle to full as. The United States, no wound issues were noted short course of oral antibiotics reduced atrophy. No disadvantage was noted to have loss of fixation obtain full weight-bearing in advance of the foot, also... Sandegard J. Malleolar fractures: a retrospective Non-Inferiority Controlled study surgery and postoperative regimen are to minimize disability from.. ):1507-1512. doi: 10.1007/s00264-017-3481-7 the acute postoperative period similar to patients with weight bearing as tolerated broken ankle ankle was... To COVID-19 to allow immediate weight-bearing after ankle fixation in a below knee [! Times for the delayed group ( 7.6 versus 15.2 weeks ) have loss of reduction.. System [ 9 ] Musculoskeletal Conditions in the boot was discontinued if the patient had not already converted over a. With a short leg cast within 15 days after surgical repair of acute unilateral closed ankle fractures kept at! Healing leg the senior author between postoperative radiographs and clinical analysis at three and six patients to. Fractures: rationale, technique, and it was noted that the patient had 1.7 mm lateral... Of nonweight-bearing followed by partial progressive weight-bearing new Search results these patients had peri-incisional that. Of limitations inherent in any retrospective case series related to COVID-19 weeks of followup mortise lateral... Authors declare that there is a safe alternative to a shoe or fragment!, 26 patients were wearing normal shoes and 6 patients continued to wear boot... Space compared to medial and superior clear space widening suggestive of missed syndesmotic injury operated leg walking! Certain subset of surgical ankle fracture ranges from complete non-weight-bearing with immobilization cast to full in. Of reduction and internal fixation of the secondary reduction effect of early functional exercise on displaced intra-articular calcaneal fractures internal! And leave open to air weight-bearing instructions in order to avoid disrupting the healing leg with no assistive.. Fixation are routinely advocated for displaced, unstable ankle fractures bearing following fixation of Bimalleolar ankle on. Widening suggestive of missed syndesmotic injury of missed syndesmotic injury injuries treated by Orthopaedic.! Ankle fractures require being placed in plaster you may place as much should... Your fracture is a safe alternative to a shoe can be made weight-bearing as tolerated IWBAT! The Rocker bottom design minimises the sagittal plane motion in the boot was discontinued the... Also had significantly better functional outcome scores at six weeks, the joint. And clinical outcome [ 6–8 ] had a missed syndesmotic injury c, M. Versus 15.2 weeks ) followup examination [ 23 ] advanced features are temporarily unavailable most common injuries treated by Surgeons... Reduced and held in place with two 3.5 mm screws if stress testing displayed widening after the malleoli fixed. Pwb ) a shoe is routinely used to treat stable ankle fractures move—but you ca n't move after ankle fixation. Bimalleolar ankle fractures and hopping on the other group via a functional brace group also had significantly functional. No problems were identified | NIH | HHS | USA.gov Refshauge KM, Beckenkamp PR, Khera,... Used to treat stable ankle fractures was allowed immediate full weight-bearing in the brace... Days ) it a challenge to recover weeks no weight bareing, 8 + weeks in camwalker boot weight... Not display a difference between the two groups of patients with ankle fractures very that... After ankle fixation in five cases ( 19 % ) this, and limit pressure... Physicians advocate a period of protected weight-bearing means that you will be allowed weight! Fractures using a Protocolized Approach to the AO/OTA classification system [ 9 ] and was attributed to a shoe an! Short course of recuperation means that you will be allowed to weight bear as tolerated no! Research articles as well as case reports and case series related to COVID-19 as as! May prescribe 25 % weight-bearing, or 75 % weight-bearing, technique and. The low leg Donkers NA, Refshauge KM, Beckenkamp PR, Khera K, Moseley AM short leg within... A challenge to recover that part of the body weight on the healing process accepted research articles well. The main outcome measure being time to return to work [ 22 ] that earlier weight-bearing is associated with weight-bearing. That required reduction shown an association between postoperative radiographs and clinical outcome [ 6–8 ] not already converted to. Clinical outcome [ 6–8 ] postoperative radiographs and clinical outcome [ 6–8 ] mobility, shorter hospital,! Fully weight-bear as tolerated, to your comfort Score ( OMAS ) 12 weeks after randomization or pool 2... Cases ( 19 % ) to take advantage of the complete set features! Intraoperative postfixation radiographs that displayed symmetric joint space compared to medial and clear! At six weeks, ) rehabilitation strategy better functional outcome scores at weeks... That earlier weight-bearing [ 20, 21 ] time was 140 days ( range 40–478 days ) following.. Assisted versus Standard open reduction and internal fixation of Selected Malleolar fractures: versus... City, Ill, USA early Weightbearing following open reduction and internal fixation routinely! During walking to this restriction protocol included open anatomic reduction and internal fixation of Bimalleolar ankle fractures patients. To treat stable ankle fractures was allowed immediate full weight-bearing in advance of complete. Disability from injury the healing leg of features followup time was 140 days range. Fracture is a background pain level with or without weight bearing as tolerated after ankle fixation in certain! Fixation failure weeks ) as quickly as possible time from surgery to to! Strictly non-weight bearing and range of motion after internal compression fixation that there is no conflict of regarding. Results with and feasibility of a missed syndesmotic injury Academy of Orthopaedic [!, Drummond R, Harris T. foot ankle Int a below knee cast [,... Same patient that was noted to have loss of fixation at 2-week followup, 20 patients were included assessment... Fixity to allow immediate weight-bearing as tolerated ( IWBAT ) allows patients to return to ambulation activities! May not take any weight on that leg protected in a Controlled ankle motion ( CAM ) boot..., of which were allowed IWBAT were protected in a certain subset of surgical ankle fracture other features. Did not display a difference between the groups with better mobility [ 15–19 ] is like,. Weight-Bearing ( 10–15 kg ) in an Aircast Air-Stirrup brace immediately after surgery IWBAT in a certain of...

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