SLR - September 2021 - Shiv Mehta

Do Early Weight Bearing and Range of Motion Affect Outcomes in Operatively Treated Ankle Fractures: A systematic Review and Meta-Analysis

Reference: 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 Aug 1;35(8):408-413.

Level of Evidence: I

Scientific Literature Review 

Reviewed By: Shiv Mehta, DPM
Residency Program: SSM Health DePaul Hospital – St. Louis, MO

Podiatric Relevance: Ankle fractures occur in varying degrees which gives rise to a variety of postoperative protocols without clear consensus in regard to early weight bearing and early range of motion (ROM). The aim of this systematic review and meta-analysis is to help answer questions about clinical outcomes and complications surrounding early weight bearing and early ROM after ankle ORIF.

Methods: A total of 20 level I studies were analyzed and data pertaining to early weightbearing and early ROM following ankle ORIF was extracted.

Results: Early weight bearing after ankle ORIF was found to not affect clinical outcomes if stable fixation was present when compared to delayed weight bearing. Likewise, early weight bearing did not correlate with an increased rate of complications nor early ROM of the ankle following ORIF with the exception of increased risk of complication in regard to wound healing but not infection.

Conclusions: Many post-operative protocols exist following ankle ORIF. Whether performed early or delayed, neither choice proved to be superior over the other in the long term and clinical outcomes remained relatively equal. Ultimately, it was shown that early ROM is safer to perform once the wound has healed. Doing so earlier demonstrated wound healing complications but not an increased risk of infection.  

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