Rockov Zachary A, Finkel Ryan A, Hashmi Sohaib Z, Byrne Connor T, Nigh Evan D, Garfinkel Jonathan H, Noori Naudereh B, Pujari Amit, Lin Carol A, Moon Charles N, Marecek Geoffrey S, Vrahas Mark S, Little Milton T M
Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
Injury. 2025 Feb;56(2):112157. doi: 10.1016/j.injury.2025.112157. Epub 2025 Jan 10.
Studies have demonstrated successful outcomes with early weightbearing following open reduction internal fixation (ORIF) of specific ankle fractures. The external validity of an early weightbearing protocol and its effects on patient-reported outcome information scores (PROMIS) has yet to be investigated. This study aimed to investigate the effects of an early weightbearing protocol for all operatively treated ankle fractures and its impact on clinical outcomes and complications.
This retrospective cohort study included 229 patients (≥ 16 years) with OTA/AO 44 A-C fractures who underwent open reduction and internal fixation (ORIF). Patients were divided into groups based on early (2-3 weeks postoperative) or delayed (>6 weeks postoperative) weightbearing protocols. Primary outcomes included PROMIS score subsets including physical function, depression, and pain interference and ankle range of motion (ROM) at each follow up visit. Secondary outcomes included complications such as implant removal for pain, prominence, or surgical site infection, revision surgery for failure of fixation or loss of reduction, and post-operative sensory or motor deficits.
There were 96 patients in the early weightbearing cohort and 133 patients in the delayed weightbearing cohort. The median follow-up time of the early weightbearing cohort was 471.47 ± 389.69 days while the delayed cohort was 459.82 ± 358.21 days. Demographics and comorbidities were distributed equally between both groups, except the presence of peripheral neuropathy which was observed more frequently in the delayed weightbearing cohort (8 versus 0, p = 0.022). Results indicated no statistically significant differences in PROMIS scores at final follow up, ankle ROM, or post-operative complications between the early and delayed weightbearing cohorts. Multivariable regression analysis identified smoking as a factor associated with worse ankle ROM at final follow-up.
This study found that early weightbearing after ORIF of unstable ankle fractures leads to similar PROMIS scores and ankle ROM without increased complications. In addition, smokers were found to have worse ankle ROM when compared to nonsmokers at final follow-up.
研究表明，特定踝关节骨折切开复位内固定术（ORIF）后早期负重可取得成功的治疗效果。早期负重方案的外部有效性及其对患者报告结局信息评分（PROMIS）的影响尚未得到研究。本研究旨在调查针对所有接受手术治疗的踝关节骨折的早期负重方案的效果及其对临床结局和并发症的影响。
这项回顾性队列研究纳入了229例年龄≥16岁、接受切开复位内固定术（ORIF）治疗的OTA/AO 44 A-C型骨折患者。患者根据早期（术后2-3周）或延迟（术后>6周）负重方案分组。主要结局包括PROMIS评分子集，包括身体功能、抑郁和疼痛干扰，以及每次随访时的踝关节活动范围（ROM）。次要结局包括并发症，如因疼痛、植入物突出或手术部位感染而取出植入物、因固定失败或复位丢失而进行翻修手术，以及术后感觉或运动功能障碍。
早期负重队列中有96例患者，延迟负重队列中有133例患者。早期负重队列的中位随访时间为471.47±3８9.69天，而延迟队列的中位随访时间为459.82±358.21天。除了延迟负重队列中更频繁观察到周围神经病变（8例对0例，p = 0.022）外，两组之间的人口统计学和合并症分布均衡。结果表明，早期和延迟负重队列在最终随访时的PROMIS评分、踝关节ROM或术后并发症方面没有统计学上的显著差异。多变量回归分析确定吸烟是最终随访时踝关节ROM较差的相关因素。
本研究发现，不稳定踝关节骨折切开复位内固定术后早期负重导致PROMIS评分和踝关节ROM相似，且并发症未增加。此外，在最终随访时，发现吸烟者的踝关节ROM比不吸烟者差。
