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

Abstract

This systematic review was performed to answer the following questions: (1) Does early weight-bearing (WB) after ankle fracture (AF) open reduction internal fixation (ORIF) affect outcomes? (2) Does early WB after AF ORIF cause an increase in complications? (3) Does early ankle motion after AF ORIF affect outcomes? and (4) Does early ankle motion after AF ORIF cause an increase in complications? Articles from 1970 to 2020 were found using the PubMed database. Level I studies of adult patients with operatively treated ankle fractures were selected. A total of 1130 cases across 20 studies fit the participant criteria. Studies were reviewed for data pertaining to the current study questions. The meta-analysis used logistic regression and standardized mean difference. Based on the current literature, early WB in operative ankle fractures with stable fixation showed no difference in outcomes when compared with delayed WB protocols. Early WB after ORIF did not significantly increase complications. Early ankle motion after AF ORIF did not have significant standardized mean differences between range of motion and immobilization outcomes. Early range of motion before wound healing may lead to an increase in complications [pooled odds ratio: 3.11, 95% confidence interval (CI): 1.64-5.90] but did not show an increase in infection. The authors recommend that early WB at 2 weeks postoperatively can be safely considered for ankle fractures when stable fixation has been obtained. Early ankle motion before wound healing is not recommended due to increased wound complications, without improvement in long-term results. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.