EWB may also provide a more functional ankle joint and an earlier return to work. Analysis of this contemporary ideology has yielded multiple biomechanical and cellular advantages.
More recently, however, early studies have begun to look at the benefits of early mobilization among ankle fractures after ORIF. Difficulties with ADLs specifically include inability to drive, limited mobility, and difficulties with hygiene, which all presumably have deleterious effects on patient outcomes. Recent research has shown that extended periods of immobilization can lead to complications such as joint stiffness, ligamentous and musculotendinous atrophy, increased time for return to work, and difficulties with activities of daily living (ADLs). The theoretical risk of fixation failure and loss of reduction secondary to inadequate immobilization and early weight bearing (EWB) drove this traditional protocol. Traditionally, after ankle open reduction and internal fixation (ORIF), six weeks of non-weight bearing (NWB) was thought to be the gold standard to allow optimal immobilization for healing.
Similarly, screws, tension band constructs, or buttress plating techniques can be used for stabilization of medial malleolus fractures. Various fixation strategies for lateral malleolar fractures have been described lag screws with neutralization plating, intramedullary devices, antiglide plating, and bridge plating in cases of comminution are some of the most commonly used techniques in practice today. Osteosynthesis techniques for bimalleolar ankle fractures are relatively well established, but operative planning can be dependent on fracture pattern, surgeon preference, and patient comorbidities. Although operative guidelines are fairly well established, postoperative weight-bearing protocols have not been well studied, and controversy exists regarding optimal time to weight bearing in this population. The majority of ankle fractures occur secondary to ground-level falls, but irrespective of the injury mechanism, fracture characteristics often dictate the need for operative stabilization. The incidence is likely to increase as the average age of the population rises, as does the amount of participation in sports-related activities. The incidence of ankle fractures is approximately 71-187 per 100,000 people per year and is one of the most common injuries treated by orthopedic surgeons. This study suggests that EWB at three weeks postoperatively does not increase markers of radiographic failure compared to six weeks of non-weight bearing (NWB), which has been regarded as the gold standard of treatment to allow for healing this may represent an improvement to rehabilitation protocols after bimalleolar ankle ORIF of unstable ankle fractures. No differences in medial clear space were detected at any postoperative interval between groups (p>0.1 at all time intervals). The EWB group on average began to weight bear at 3.1 + 1.4 weeks postoperatively, whereas the LWB group began at 7.2 + 2.1 weeks postoperatively (p0.1 at all time intervals) were not notably different between groups. There were no significant demographic differences between groups. There were 38 patients (40%) in the EWB group and 57 patients (60%) comprising the LWB cohort. Postoperatively, patients were evaluated at regular intervals for fracture union, signs of implant failure, and evidence of medial clear space widening radiographically. This study seeks to clarify postoperative fracture union rates, rates of hardware loosening or failure, and radiographic medial clear space changes when comparing EWB to late weight bearing (LWB) following open reduction and internal fixation (ORIF).Ī total of 95 patients with either bimalleolar (66%) or bimalleolar equivalent (34%) fractures who underwent ORIF were retrospectively reviewed. Weight bearing was allowed at three weeks in the EWB group and when signs of radiographic union were noted in the LWB group. Although operative indications and subsequent stabilization of these fractures have not significantly changed, postoperative protocols remain highly variable. Effects of early weight bearing (EWB) on fracture characteristics in operatively stabilized bimalleolar and bimalleolar equivalent ankle fractures remain poorly publicized. Ankle fractures are common orthopedic injuries.
0 kommentar(er)
