Swart Eric, Bezhani Hariklia, Greisberg Justin, Vosseller J Turner
Columbia University Medical Center, 622 West 168th Street, PH-1130, New York, NY 10032, United States.
Columbia University Medical Center, 622 West 168th Street, PH-1130, New York, NY 10032, United States.
Injury. 2015;46(6):1127-30. doi: 10.1016/j.injury.2015.03.029. Epub 2015 Mar 18.
Ankle fractures are common injuries treated routinely by orthopaedic surgeons. A variety of different post-operative protocols have been described with differing periods of non-weight bearing after surgery. The aim of this study was to identify how patient injury characteristics and medical comorbidities contribute to the period of non-weight bearing chosen by orthopaedic surgeons after open reduction and internal fixation of rotational ankle fractures.
A cross sectional expert opinion survey was administered to members of the AOFAS as well as OTA to determine how long they would instruct patients to be non-weight bearing after open reduction and internal fixation of ankle fractures. Three different injury characteristics were described: supination external rotation type 4 equivalents, bimalleolar, and trimalleolar patterns. These patterns were combined with three different medical statuses: young and healthy, older and healthy, and older with significant medical comorbidity. Respondents selected how long they would keep the patient non-weight bearing after surgery for each of the potential scenarios. Finally, they were directly asked which factors they felt affected their decision about length of time to keep patients non-weight bearing.
Seven hundred and two surgeons (31%) responded to the survey. The average time of non-weight bearing selected varied from 4.9 (± 3.1) weeks for in young, healthy patients with SER4 equivalent injuries to 7.6 (± 6.0) weeks for older patients with medical comorbidities with trimalleolar fractures. Responses had a high degree of heterogeneity, but both injury pattern and medical status were significant predictors of non-weight bearing period (p<0.01), with medical status the stronger determinant.
There is significant variation among orthopaedic surgeons when selecting period of non-weight bearing after fixation of ankle fractures, with both injury pattern and medical comorbidity playing a role in decision of time to keep patient non-weight bearing. Further research further evaluating the relationship between these factors and safe periods of non-weight bearing could help identify patients that may benefit from earlier mobilization, and improve surgeon's comfort with early mobilization.
Therapeutic Level V.
踝关节骨折是骨科医生常规治疗的常见损伤。已经描述了多种不同的术后方案，术后非负重期各不相同。本研究的目的是确定患者的损伤特征和合并症如何影响骨科医生在旋转移位型踝关节骨折切开复位内固定术后选择的非负重期。
对美国足踝外科协会（AOFAS）和骨创伤协会（OTA）的成员进行了一项横断面专家意见调查，以确定他们在踝关节骨折切开复位内固定术后会指导患者非负重多长时间。描述了三种不同的损伤特征：旋后外旋4度型等效损伤、双踝骨折和三踝骨折模式。这些模式与三种不同的健康状况相结合：年轻健康、年长健康和患有严重合并症的年长患者。受访者针对每种可能的情况选择术后让患者非负重的时长。最后，直接询问他们认为哪些因素影响了他们关于让患者非负重时长的决定。
702名外科医生（31%）回复了调查。选择的平均非负重时间从年轻健康的旋后外旋4度型等效损伤患者的4.9（±3.1）周，到患有合并症的老年三踝骨折患者的7.6（±6.0）周不等。回答具有高度异质性，但损伤模式和健康状况都是非负重期的重要预测因素（p<0.01），健康状况是更强的决定因素。
骨科医生在选择踝关节骨折固定术后的非负重期时存在显著差异，损伤模式和合并症在决定患者非负重时间方面都起作用。进一步研究这些因素与安全非负重期之间的关系，可能有助于识别可能从早期活动中受益的患者，并提高外科医生对早期活动的认可度。
治疗性五级。
