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, 2015, 491976

Immediate Weight-Bearing After Ankle Fracture Fixation

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Immediate Weight-Bearing After Ankle Fracture Fixation

Reza Firoozabadi et al. Adv Orthop.

Abstract

We believe that a certain subset of surgical ankle fracture patients can be made weight-bearing as tolerated immediately following surgery. Immediate weight-bearing as tolerated (IWBAT) allows patients to return to ambulation and activities of daily living faster and may facilitate rehabilitation. A prospectively gathered orthopaedic trauma database at a Level 1 trauma center was reviewed retrospectively to identify patients who had ORIF after unstable ankle injuries treated by the senior author. Patients were excluded if they were not IWBAT based on specific criteria or if they did meet followup requirement. Only 1/26 patients was noted to have loss of fixation. This was found at the 6-week followup and was attributed to a missed syndesmotic injury. At 2-week followup, 2 patients had peri-incisional erythema that resolved with a short course of oral antibiotics. At 6-week followup, 20 patients were wearing normal shoes and 6 patients continued to wear the CAM Boot for comfort. To conclude, IWBAT in a certain subset of patients with stable osteosynthesis following an ankle fracture could potentially be a safe alternative to a period of protected weight-bearing.

Figures

Figure 1
Figure 1
Exclusion diagram for 136 patients with ankle fractures over 23-month period.
Figure 2
Figure 2
Single case of loss of reduction, suspect secondary to missed syndesmotic injury. (a) Preoperative mortise and lateral radiographs. (b) Immediate postoperative mortise and lateral radiographs. (c) 6 weeks of followup mortise and lateral radiographs.
Figure 3
Figure 3
Intraoperative fluoroscopic images of failure case. (a) Preexternal rotation stress mortise view. (b) External rotation stress mortise view. Medial clear space widening suggestive of missed syndesmotic injury.

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