Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Foot Ankle Surg. 2022 Oct;28(7):827-835. doi: 10.1016/j.fas.2022.03.003. Epub 2022 Mar 11.
While open reduction and internal fixation is currently considered the optimum treatment option for displaced ankle fractures, the most optimal post-operative rehabilitation strategy in this setting remains unclear. The objective of this investigation was to compare the effect of early vs. late weight bearing and ankle mobilization in the post-operative management of ankle fractures.
Medline, Embase, CENTRAL, Scopus, CINHAL, and Web of Science were searched to identify randomized controlled trials (RCTs) and quasi-RCTs. Two review authors screened articles, abstracted data, and evaluated risk of bias in duplicate. Outcomes of interest included post-operative ankle function and overall time to return to work. Studies on weight bearing and ankle mobilization were analysed separately and all data were pooled using random-effects models.
Eighteen trials were included in the review of which 14 were included in the meta-analysis of at least one outcome of interest. Majority of the studies presented a high overall risk of bias. Early weight bearing demonstrated significantly better short-term postoperative functional scores at 6-9 weeks postoperatively (SMD: 0.39, 95% CI: 0.19, 0.58; p < 0.0001; I = 0%). However, the functional effect of early weight bearing compared to late weight bearing gradually became equivalent by the 6 month postoperative time-period. Early weight bearing also demonstrated a significant reduction in the time to return to work/daily activities (MD: -12.29, 95% CI: -17.39, -7.19; p < 0.0001; I = 0%). In comparison, no significant differences were found between early ankle mobilization/exercises and immobilization.
Our findings suggest a potential role of EWB in improving post-operative ankle-function in the short-term and reducing the overall time to return to work/daily activities, but no clinical benefit associated with early ankle mobilization post-surgery.
虽然切开复位内固定目前被认为是治疗移位踝关节骨折的最佳治疗选择，但在这种情况下，最理想的术后康复策略仍不清楚。本研究的目的是比较术后早期负重与晚期负重对踝关节骨折的影响。
通过检索 Medline、Embase、CENTRAL、Scopus、CINHAL 和 Web of Science，我们共识别了随机对照试验（RCT）和准 RCT。两名综述作者独立筛选文章、提取数据，并评估偏倚风险。感兴趣的结局包括术后踝关节功能和恢复工作/日常活动的总时间。对负重和踝关节活动的研究分别进行分析，所有数据均采用随机效应模型进行汇总。
本综述共纳入 18 项试验，其中 14 项试验的至少一项结局指标纳入了荟萃分析。大多数研究的整体偏倚风险较高。与晚期负重相比，早期负重在术后 6-9 周时具有明显更好的短期术后功能评分（SMD：0.39，95%CI：0.19，0.58；p<0.0001；I²=0%）。然而，早期负重与晚期负重相比的功能效果在术后 6 个月时逐渐变得相当。早期负重也显著缩短了恢复工作/日常活动的时间（MD：-12.29，95%CI：-17.39，-7.19；p<0.0001；I²=0%）。相比之下，早期踝关节活动与固定相比，没有显著差异。
我们的研究结果表明，EWB 可能在改善短期踝关节功能和缩短整体恢复工作/日常活动时间方面发挥作用，但术后早期踝关节活动并没有带来临床获益。
