Fram Brianna R, Rogero Ryan G, Chang Gerard, Krieg James C, Raikin Steven M
Thomas Jefferson University Department of Orthopaedic Surgery and the Rothman Orthopaedic Institute, Philadelphia, PA; and.
Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
J Orthop Trauma. 2021 Jun 1;35(6):308-314. doi: 10.1097/BOT.0000000000002003.
We studied the safety of immediate weight-bearing as tolerated (IWBAT) and immediate range of motion (IROM) after open reduction internal fixation (ORIF) of selected malleolar ankle fractures (defined as involving bony or ligamentous disruption of 2 or more of the malleoli or syndesmosis without articular comminution) and attempted to identify risk factors for complications.
Retrospective case-control study.
Level 1 Urban Trauma Center and multiple community hospitals, orthopedic specialty hospitals, and outpatient surgicenters within one metropolitan area.
PATIENTS/PARTICIPANTS: Of 268 patients at our level 1 trauma center who underwent primary ORIF of a selected malleolar fracture from 2013 to 2018, we identified 133 (49.6%) who were selected for IWBAT and IROM. We used propensity score matching to identify 172 controls who were non-weight-bearing (NWB) and no range of motion for 6 weeks postoperatively. The groups did not differ significantly in age, body mass index, Charleston Comorbidity Index, smoking status, diabetes status, malleoli involved, percentages undergoing medial malleolus (60.9% IWBAT vs. 51.7% NWB), posterior malleolus (24.1% IWBAT, 26.7% NWB), or syndesmosis fixation (41.4% IWBAT, 42.4% NWB, P = 0.85).
IWBAT and IROM after ankle ORIF versus NWB for 6 weeks.
Postoperative complications, including delayed wound healing, superficial or deep infection, and loss of reduction.
There was no significant difference in total complications (P = 0.41), nonoperative complications (P = 0.53), or operative complications, including a loss of reduction (P = 0.89). We did not identify any factors associated with an increased complication risk, including posterior malleolus or syndesmosis fixation, diabetes, age, or preinjury-assisted ambulation.
We failed to demonstrate a difference in complications in general and loss of reduction in particular when allowing immediate weight-bearing/ROM in selected cases of operatively treated malleolar fractures, suggesting this may be safe. Future prospective randomized studies are necessary to determine if immediate weight-bearing/ROM is safe and whether it offers any benefits to patients with operatively treated malleolar fractures.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
我们研究了特定踝关节骨折切开复位内固定术（ORIF）后耐受的即刻负重（IWBAT）和即刻活动范围（IROM）的安全性（特定踝关节骨折定义为涉及两个或更多踝关节或下胫腓联合的骨或韧带断裂且无关节粉碎），并试图确定并发症的危险因素。
回顾性病例对照研究。
一级城市创伤中心以及一个大都市地区内的多家社区医院、骨科专科医院和门诊手术中心。
患者/参与者：在我们一级创伤中心2013年至2018年接受特定踝关节骨折初次ORIF的268例患者中，我们确定了133例（49.6%）被选择进行IWBAT和IROM。我们使用倾向评分匹配法确定了172例对照组患者，他们术后6周不负重（NWB）且无活动范围。两组在年龄、体重指数、查尔斯顿合并症指数、吸烟状况、糖尿病状况、受累踝关节、接受内踝固定的百分比（IWBAT组为60.9%，NWB组为51.7%）、后踝固定的百分比（IWBAT组为24.1%，NWB组为26.7%）或下胫腓联合固定的百分比（IWBAT组为41.4%，NWB组为42.4%，P = 0.85）方面无显著差异。
踝关节ORIF后IWBAT和IROM与6周NWB。
术后并发症，包括伤口愈合延迟、浅表或深部感染以及复位丢失。
总并发症（P = 0.41）、非手术并发症（P = 0.53）或手术并发症（包括复位丢失，P = 0.89）方面无显著差异。我们未发现任何与并发症风险增加相关的因素，包括后踝或下胫腓联合固定、糖尿病、年龄或伤前辅助行走情况。
在特定手术治疗的踝关节骨折病例中允许即刻负重/活动范围时，我们未能证明总体并发症尤其是复位丢失方面存在差异，这表明这可能是安全的。未来有必要进行前瞻性随机研究，以确定即刻负重/活动范围是否安全以及它是否对手术治疗的踝关节骨折患者有任何益处。
治疗性三级。有关证据水平的完整描述，请参阅作者须知。
