Ankle Fractures, Surgery
Conditions
Keywords
ankle, fracture, rehabilitation, weightbearing, early, late
Brief summary
This single-centre historical control group comparative study will compare outcomes of surgically-treated rotational ankle fractures and the current routine practice of early protected weightbearing and range of motion with immediate unprotected weightbearing as tolerated and range of motion after ankle open reduction and internal fixation.
Detailed description
Ankle fractures are among the most common injuries, making up 9% of all fractures. Rotational ankle fractures are among the most common of all fractures, with an incidence averaging 4.2 per 1,000 individuals annually. These fractures range from minimal injuries amenable to non-surgical management to complex injuries with potential of long-term sequelae. Known risk factors for ankle fractures are age, body mass index and previous ankle fracture, with the highest incidence in elderly women. Most ankle fractures are low-energy injuries which occur when the body rotates about a planted foot, whether it be during sports, normal gait, or otherwise. Stable ankle fractures are generally treated non-surgically, while unstable fractures are usually treated with surgical reduction and fixation, with indications previously well-described and published. However, the post-operative management of such injuries is still controversial, with large variability between care providers. Protocols range from complete immobilization of the affected ankle and non-weightbearing to early range-of-motion (ROM) and weightbearing (WB). Studies have compared immobilization and non-WB to early ROM and WB but results have been mixed, with the most recent study demonstrating safety and advantages to protected WB and ROM at two weeks post-operatively versus non-WB and immobilization for six weeks. The Investigators intend to expand on the studies above and propose a single-centre historical control group comparative study to compare outcomes of surgically-treated rotational ankle fractures and the current routine practice of early protected weightbearing and range of motion with immediate unprotected weightbearing as tolerated and range of motion after ankle open reduction and internal fixation.
Interventions
OTHERLate Rehabilitation
Post-0p: Non weight-bearing and no range of motion for 2 weeks post treatment. 2 weeks: Splint removed, removable pre-fabricated walking boot applied. WB as tolerated with boot, range of motion out of boot. 6 weeks: Boot discontinued and full unrestricted and unprotected WB and ROM permitted 6 weeks:
OTHEREarly Rehabilitation
Weightbearing and range of motion as tolerated within the limitations of participant's own comfort. Use of ambulatory aides of any kind is permitted as needed without restriction. No brace or splint of any kind is permitted
Sponsors
Fraser Orthopaedic Research Society
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* lateral malleolus fracture with talar shaft * vertical shear medial malleolus fracture without superior articular involvement * bimalleolar fracture * any ankle fracture with posterior malleolus fragment involving 25% or less of the articular surface on the lateral ankle radiograph * 43.B1 (pure split of distal tibia - but only if does not involve any of tibial plafond, i.e., only the vertical split of medial malleolus) * 44.A1 (Weber A) * 44.A2 (Bimalleolar) * 44.A3 (posterior malleolus involvement - but only if \< 25% articular involvement on lateral x-ray) * 44-B1 (Isolated) * 44.B2 (with medial lesion) * 44.B3 (with medial lesion & Volkmann's #) * closed, Gustilo-Anderson Grade I or Grade II open fractures are included * willing and able to sign the consent * willing and able to follow the protocol and attend follow-up visits * able to read and understand English or have an interpreter available
Exclusion criteria
* skeletal immaturity demonstrated radiographically by open physes * previous ipsilateral ankle surgery * bilateral ankle fractures * non ambulatory prior to injury * inability to comply with postoperative protocol (i.e., cognitive impairment) * medical comorbidity precluding surgery * poorly controlled diabetes (i.e. dense neuropathy / hx of ulcers / sensory deficit) * polytrauma patients (other injuries involving the ipsi/contralateral lower limbs, including the hip, that would interfere with mobilization/rehabilitation) * surgical date \> 14 days (time of injury to OR) * Gustilo-Anderson grade III open fractures * tibial plafond fractures * active infection at the surgical site diagnosed clinically by the attending surgeon * any ankle fracture with posterior malleolus fragment involving more than 25% of the articular surface on the lateral ankle radiograph * any medial malleolus fracture involving the superior articular surface * any ankle fracture requiring syndesmosis fixation * any ankle fracture-dislocation * incarceration * likely problems, in the judgment of the investigator, with maintaining follow-up
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Olerud and Molander Score | 6 weeks post treatment | An assessment of symptoms after ankle fracture. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| WPAI:SHP Work Productivity and Activity Impairment Questionnaire: Specific Health Problem | 2, 6 and 12 weeks post treatment | A questionnaire pertaining to the effect of the participant's ankle fracture on their ability to work and perform regular activities. |
| Range of Motion | 2, 6 and 12 weeks post treatment | Amount of ankle dorsiflexion and plantarflexion (measured in degrees) as determined by goniometer assessment, as well as total arc of ankle ROM (dorsiflexion+ plantarflexion). This will be measured on both ankles for comparison. |
| Wound Healing | 2, 6 and 12 weeks post treatment | Complications regarding the surgical wound, including but not limited to signs of infection or dehiscence. |
| EQ-5D | 2, 6 and 12 weeks post treatment | Health Related quality of life outcome measure using five dimensions: Mobility, self-care, usual activities, pain/discomfort and anxiety/depression. |
| Need for Re-operation | 2, 6 and 12 weeks post treatment | Any issue, whether it be a wound complication or fracture complication, requiring re-operation. |
| Time to Return to Work | 2, 6 and 12 weeks post treatment | The chronological time between the date of surgery to the first day the participant returned to occupational duties, if currently employed and returns to work within the 12 weeks postoperative follow-up period. For the purposes of this study, students enrolled in educational activities will have their schooling treated as their occupational duty. |
| Radiographic assessment | 2, 6 and 12 weeks post treatment | Assessment of alignment, hardware fixation, fracture reduction and loss of reduction (defined as any shft of 2mm or more in fracture position) |
| Fracture Healing | 2, 6 and 12 weeks post treatment | Radiographic assessment to determine healing, loss of reduction, loss of hardware fixation, or ankle alignment. |
Countries
Canada
Outcome results
None listed