Clinical study on weight-bearing time after internal fixation of ankle fracture_West China Medical Journal

Authors：

ZHANG Xiafen , WANG Jie , JIANG Weigang , XU Haibo ,  HE Hanliang

Department of Orthopedic Surgery, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu 215000, P. R. China;

Corresponding author：

HE Hanliang, Email: heanlight@163.com

Keywords：

Ankle fracture; early weight bearing; postoperative rehabilitation

DOI：

10.7507/1002-0179.202207156

Video：

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Objective To explore the choice of weight-bearing time and the clinical effect of different starting time of weight bearing after internal fixation of ankle fracture. Methods A total of 48 patients undergoing routine internal fixation for closed ankle fractures were selected. They were randomly divided into a tiral group and a control group, with 24 patients in each group. The patients in the tiral group started weight bearing one week after operation, while the ones in the control group did that four weeks after operation. The two groups were followed up for evaluation according to the modified Weber scale 2, 4, 8, and 12 weeks after operation, and the scale scores were presented as median (lower quartile, upper quartile). Results The fractures recovered well and no complications occurred. Two weeks after operation, the pain score [3.00 (2.00, 3.00) vs. 2.00 (1.00, 2.00)] and swelling score [3.00 (3.00, 4.00) vs. 2.00 (1.00, 2.00)] were significantly different between the trial group and the control group (P<0.05), but there was no significant difference in other indexes of the modified Weber scale between the two groups (P>0.05). Four weeks after operation, the swelling score was significantly different between the two groups [2.00 (2.00, 3.00) vs. 1.00 (0.00, 1.00), P<0.05], but there was no significant difference in other indexes of the modified Weber scale between the two groups (P>0.05). Eight and twelve weeks after operation, there was no significant difference in any of the modified Weber scale scores between the two groups (P>0.05). Conclusions It is feasible to start weight bearing one week after internal fixation of ankle fracture. Although swelling and pain will occur, it does not affect fracture healing or functional recovery.

Citation： ZHANG Xiafen, WANG Jie, JIANG Weigang, XU Haibo, HE Hanliang. Clinical study on weight-bearing time after internal fixation of ankle fracture. West China Medical Journal, 2022, 37(11): 1661-1665. doi: 10.7507/1002-0179.202207156 Copy

1.	唐康来, 苟小力, 穆米多. 重视踝关节骨折畸形愈合的预防与正确处理. 中华创伤骨科杂志, 2022, 24(1): 6-9.
2.	Xu Y, Kang R, Li M, et al. The clinical efficacy of suture-button fixation and trans-syndesmotic screw fixation in the treatment of ankle fracture combined with distal tibiofibular syndesmosis injury: a retrospective study. J Foot Ankle Surg, 2022, 61(1): 143-148.
3.	Park JY, Kim BS, Kim YM, et al. Early weightbearing versus nonweightbearing after operative treatment of an ankle fracture: a multicenter, noninferiority, randomized controlled trial. Am J Sports Med, 2021, 49(10): 2689-2696.
4.	Pyle C, Kim-Orden M, Hughes T, et al. Effect of early weightbearing following open reduction and internal fixation of unstable ankle fractures on wound complications or failures of fixation. Foot Ankle Int, 2019, 40(12): 1397-1402.
5.	Bretherton CP, Claireaux HA, Achten J, et al. Protocol for the Weight bearing in Ankle Fractures (WAX) trial: a multicentre prospective non-inferiority trial of early versus delayed weight-bearing after operatively managed ankle fracture. BMC Musculoskelet Disord, 2021, 22(1): 672-681.
6.	Smeeing DPJ, Houwert RM, Briet JP, et al. Weight-bearing or non-weight-bearing after surgical treatment of ankle fractures: a multicenter randomized controlled trial. Eur J Trauma Emerg Surg, 2020, 46(1): 121-130.
7.	Finsen V, Saetermo R, Kibsgaard L, et al. Early postoperative weight-bearing and muscle activity in patients who have a fracture of the ankle. J Bone Joint Surg Am, 1989, 71(1): 23-27.
8.	Hughes JL, Weber H, Willenegger H, et al. Evaluation of ankle fractures: non-operative and operative treatment. Clin Orthop Relat Res, 1979(138): 111-119.
9.	王雪, 李璐兵, 帕尔哈提, 等. 踝关节骨折术后早期能否负重的生物力学分析. 中华骨与关节外科杂志, 2016, 9(6): 515-519.
10.	Tan EW, Sirisreetreerux N, Paez AG, et al. Early weightbearing after operatively treated ankle fractures: a biomechanical analysis. Foot Ankle Int, 2016, 37(6): 652-658.
11.	Schmittenbecher PP. What must we respect in articular fractures in childhood?. Injury, 2005, 36(1): A35-A43.
12.	Gorczyca JT. Early, rather than late, weight-bearing and range-of motion exercise improved early function but not time to return to work after surgical fixation of unstable ankle fractures. J Bone Joint Surg Am, 2017, 99(4): 350.
13.	Schubert J, Lambers KTA, Kimber C, et al. Effect on overall health status with weightbearing at 2 weeks vs 6 weeks after open reduction and internal fixation of ankle fractures. Foot Ankle Int, 2020, 41(6): 658-665.
14.	Smeeing DP, Houwert RM, Briet JP, et al. Weight-bearing and mobilization in the postoperative care of ankle fractures: a systematic review and meta-analysis of randomized controlled trials and cohort studies. PLoS One, 2015, 10(2): e0118320.
15.	Jansen H, Jordan M, Frey S, et al. Active controlled motion in early rehabilitation improves outcome after ankle fractures: a randomized controlled trial. Clin Rehabil, 2018, 32(3): 312-318.
16.	Sernandez H, Riehl J, Fogel J. Do early weight-bearing and range of motion affect outcomes in operatively treated ankle fractures: a systematic review and meta-analysis. J Orthop Trauma, 2021, 35(8): 408-413.
17.	Güngör HR, Büker N, Şavkın R, et al. Early unprotected weight bearing and pre-scheduled supervised rehabilitation program after surgical treatment of ankle fractures. Arch Bone Jt Surg, 2022, 10(2): 183-189.
18.	杨红梅, 赵贵凤, 沈文云, 等. 个体化护理干预对踝关节骨折患者术后功能锻炼依从性、疼痛程度以及恢复效果的促进作用. 足踝外科电子杂志, 2021, 8(3): 50-54.
19.	Heare A, Kramer N, Salib C, et al. Early versus late weight-bearing protocols for surgically managed posterior wall acetabular fractures. Orthopedics, 2017, 40(4): e652-e657.
20.	周建国. 踝关节骨折术后早期部分负重康复锻炼结合中药熏洗临床观察. 实用中医药杂志, 2022, 38(6): 909-910.

1. 唐康来, 苟小力, 穆米多. 重视踝关节骨折畸形愈合的预防与正确处理. 中华创伤骨科杂志, 2022, 24(1): 6-9.
2. Xu Y, Kang R, Li M, et al. The clinical efficacy of suture-button fixation and trans-syndesmotic screw fixation in the treatment of ankle fracture combined with distal tibiofibular syndesmosis injury: a retrospective study. J Foot Ankle Surg, 2022, 61(1): 143-148.
3. Park JY, Kim BS, Kim YM, et al. Early weightbearing versus nonweightbearing after operative treatment of an ankle fracture: a multicenter, noninferiority, randomized controlled trial. Am J Sports Med, 2021, 49(10): 2689-2696.
4. Pyle C, Kim-Orden M, Hughes T, et al. Effect of early weightbearing following open reduction and internal fixation of unstable ankle fractures on wound complications or failures of fixation. Foot Ankle Int, 2019, 40(12): 1397-1402.
5. Bretherton CP, Claireaux HA, Achten J, et al. Protocol for the Weight bearing in Ankle Fractures (WAX) trial: a multicentre prospective non-inferiority trial of early versus delayed weight-bearing after operatively managed ankle fracture. BMC Musculoskelet Disord, 2021, 22(1): 672-681.
6. Smeeing DPJ, Houwert RM, Briet JP, et al. Weight-bearing or non-weight-bearing after surgical treatment of ankle fractures: a multicenter randomized controlled trial. Eur J Trauma Emerg Surg, 2020, 46(1): 121-130.
7. Finsen V, Saetermo R, Kibsgaard L, et al. Early postoperative weight-bearing and muscle activity in patients who have a fracture of the ankle. J Bone Joint Surg Am, 1989, 71(1): 23-27.
8. Hughes JL, Weber H, Willenegger H, et al. Evaluation of ankle fractures: non-operative and operative treatment. Clin Orthop Relat Res, 1979(138): 111-119.
9. 王雪, 李璐兵, 帕尔哈提, 等. 踝关节骨折术后早期能否负重的生物力学分析. 中华骨与关节外科杂志, 2016, 9(6): 515-519.
10. Tan EW, Sirisreetreerux N, Paez AG, et al. Early weightbearing after operatively treated ankle fractures: a biomechanical analysis. Foot Ankle Int, 2016, 37(6): 652-658.
11. Schmittenbecher PP. What must we respect in articular fractures in childhood?. Injury, 2005, 36(1): A35-A43.
12. Gorczyca JT. Early, rather than late, weight-bearing and range-of motion exercise improved early function but not time to return to work after surgical fixation of unstable ankle fractures. J Bone Joint Surg Am, 2017, 99(4): 350.
13. Schubert J, Lambers KTA, Kimber C, et al. Effect on overall health status with weightbearing at 2 weeks vs 6 weeks after open reduction and internal fixation of ankle fractures. Foot Ankle Int, 2020, 41(6): 658-665.
14. Smeeing DP, Houwert RM, Briet JP, et al. Weight-bearing and mobilization in the postoperative care of ankle fractures: a systematic review and meta-analysis of randomized controlled trials and cohort studies. PLoS One, 2015, 10(2): e0118320.
15. Jansen H, Jordan M, Frey S, et al. Active controlled motion in early rehabilitation improves outcome after ankle fractures: a randomized controlled trial. Clin Rehabil, 2018, 32(3): 312-318.
16. Sernandez H, Riehl J, Fogel J. Do early weight-bearing and range of motion affect outcomes in operatively treated ankle fractures: a systematic review and meta-analysis. J Orthop Trauma, 2021, 35(8): 408-413.
17. Güngör HR, Büker N, Şavkın R, et al. Early unprotected weight bearing and pre-scheduled supervised rehabilitation program after surgical treatment of ankle fractures. Arch Bone Jt Surg, 2022, 10(2): 183-189.
18. 杨红梅, 赵贵凤, 沈文云, 等. 个体化护理干预对踝关节骨折患者术后功能锻炼依从性、疼痛程度以及恢复效果的促进作用. 足踝外科电子杂志, 2021, 8(3): 50-54.
19. Heare A, Kramer N, Salib C, et al. Early versus late weight-bearing protocols for surgically managed posterior wall acetabular fractures. Orthopedics, 2017, 40(4): e652-e657.
20. 周建国. 踝关节骨折术后早期部分负重康复锻炼结合中药熏洗临床观察. 实用中医药杂志, 2022, 38(6): 909-910.

West China Medical Journal

Clinical study on weight-bearing time after internal fixation of ankle fracture

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