Güngör Harun R, Büker Nihal, Şavkın Raziye, Ök Nusret
Pamukkale University, Orthopedics and Traumatology Department, Denizli, Turkey.
Pamukkale University, School of Physical Therapy and Rehabilitation, Denizli, Turkey.
Arch Bone Jt Surg. 2022 Feb;10(2):183-189. doi: 10.22038/ABJS.2021.55767.2777.
Ankle fractures represent one of the most common orthopedic injuries in the lower extremity Weight-bearing and rehabilitation protocols after surgical treatment of ankle fracture have recently evolved from traditional methods to full weight-bearing protocols. However, more evidence is needed on unprotected immediate weight-bearing along with a standardized rehabilitation program. The purpose of this study was to evaluate effects of unprotected immediate weight-bearing as tolerated and an eight-week prescheduled supervised rehabilitation program on the mid-term clinical and functional outcomes of surgically treated ankle fractures, and to compare functional results with the unaffected side.
Eighty patients (24F and 56M) who underwent rigid fixation of bimalleolar ankle fractures were included (mean age 41.57±13.22 years). Preoperative radiographs and computed tomography scans were used to evaluate and classify the fractures. The fractures were classified using Lauge-Hansen classification system. Ankle ROMs, Pain Disability Index (PDI), American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scores, and Short Form-36 scores were evaluated. Patients were allowed unprotected weight-bearing on the immediate postoperative period and a standardized supervised prescheduled rehabilitation program was undertaken following surgery.
The mean follow-up period was 30.32±6.91 months. Based on Lauge-Hansen classification, supination-external rotation injuries were found in 32(40%) patients, supination adduction injuries in 14(17.4%) patients, pronation-external rotation injuries in 28(35%) patients, and pronation-abduction fractures in 6(7.6%) patients. The solid union was achieved in all patients at the final follow-up. The mean PDI score was 12.78±14.78, and the AOFAS score was 80.93±17.24. Although patients' health-related quality of life was at a good level, the injured-side ankle ROM was lower than the healthy side ( ).
Satisfactory clinical and functional outcome can be achieved at mid-term with unprotected weight-bearing as tolerated and pre-scheduled supervised eight-week rehabilitation program following rigid internal fixation of ankle fractures. However, this protocol is not studied in patients with associated comorbidities.
踝关节骨折是下肢最常见的骨科损伤之一。踝关节骨折手术治疗后的负重和康复方案最近已从传统方法演变为全负重方案。然而，对于无保护的即刻负重以及标准化康复计划，还需要更多证据。本研究的目的是评估无保护的即刻耐受负重以及为期八周的预定监督康复计划对手术治疗的踝关节骨折中期临床和功能结局的影响，并将功能结果与未受影响侧进行比较。
纳入80例接受双踝骨折坚强内固定的患者（24例女性和56例男性）（平均年龄41.57±13.22岁）。术前X线片和计算机断层扫描用于评估和分类骨折。骨折采用Lauge-Hansen分类系统进行分类。评估踝关节活动度、疼痛残疾指数（PDI）、美国矫形足踝协会（AOFAS）踝-后足评分和简短健康调查问卷-36评分。患者在术后即刻允许无保护负重，并在术后进行标准化的监督预定康复计划。
平均随访期为30.32±6.91个月。根据Lauge-Hansen分类，32例（40%）患者为旋后-外旋损伤，14例（17.4%）患者为旋后-内收损伤，28例（35%）患者为旋前-外旋损伤，6例（7.6%）患者为旋前-外展骨折。所有患者在最终随访时均实现了牢固愈合。平均PDI评分为12.78±14.78，AOFAS评分为80.93±17.24。尽管患者的健康相关生活质量处于良好水平，但患侧踝关节活动度低于健侧（ ）。
踝关节骨折坚强内固定后，采用无保护的耐受负重和预定的八周监督康复计划，中期可获得满意的临床和功能结局。然而，该方案未在伴有合并症的患者中进行研究。
