Weight-bearing and mobilization in the postoperative care of ankle fractures: a systematic review and meta-analysis of randomized controlled trials and cohort studies

Diederik P J Smeeing, Roderick M Houwert, Jan Paul Briet, Johannes C Kelder, Michiel J M Segers, Egbert Jan M M Verleisdonk, Luke P H Leenen, Falco Hietbrink, Diederik P J Smeeing, Roderick M Houwert, Jan Paul Briet, Johannes C Kelder, Michiel J M Segers, Egbert Jan M M Verleisdonk, Luke P H Leenen, Falco Hietbrink

Abstract

Purpose: To determine the effectiveness and safety of interventions used for rehabilitation after open reduction and internal fixation of ankle fractures.

Methods: A systematic review and meta-analysis was performed using both randomized trials and cohort studies. The effect of mobilization, weight-bearing, and unprotected weight-bearing as tolerated on postoperative recovery was compared using the Olerud Molander score, return to work/daily activities, and the rate of complications.

Results: A total of 25 articles were included. Ankle exercises resulted in earlier return to work and/or daily activities compared to immobilization (mean difference (MD) -20.76 days; 95% confidence interval (CI) -40.02 to -1.50). There was no difference in the rate of complications between exercises and immobilization (risk ratio (RR) 1.22; 95% CI 0.60 to 2.45) or between early and late weight-bearing (RR 1.26; 95%CI 0.56 to 2.85).

Interpretation: Results of this meta-analysis show that following ankle surgery, 1) active exercises accelerate return to work and daily activities compared to immobilization, 2) early weight-bearing tends to accelerate return to work and daily activities compared to late weight-bearing. Active exercises in combination with immediate weight-bearing may be a safe option.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Process from initial search to…
Fig 1. Process from initial search to final inclusion of studies on postoperative care of ankle fractures.
A flowchart following the PRISMA guidelines of the search strategy.
Fig 2. Risk of bias assessment.
Fig 2. Risk of bias assessment.
—indicates a high risk of bias; + indicates a low risk of bias;? indicates an unclear risk of bias.
Fig 3. Effect of mobilization; return to…
Fig 3. Effect of mobilization; return to work/daily activities.
The mean difference (SD) on the return to work/daily activities is shown between the ankle exercises groups and the immobilization groups.
Fig 4. Effect of weight-bearing; return to…
Fig 4. Effect of weight-bearing; return to work/daily activities.
The mean difference (SD) on the return to work/daily activites is shown between the early weight-bearing groups and the late weight-bearing groups.

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