Is 2-week cast wearing followed by 4-week functional bracing superior to 6-week cast immobilization after surgery for ankle fractures? A 2-year follow-up of a randomized controlled trial

Review written by Dr Chris Bleakley info

Key Points

  1. This study provides further evidence that early mobilization after ankle open reduction internal fixation appears safe and feasible. Initiating progressive weight-bearing at two weeks post-surgery produced comparable outcomes to standard six-week immobilization, with no increase in complications.
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BACKGROUND AND OBJECTIVE

Ankle fractures are the third most common fracture requiring hospitalization (1), with many requiring surgical fixation. Post-surgical management traditionally includes six weeks of immobilization and non-weightbearing, followed by progressive loading. However, previous meta-analyses have been unable to determine the optimal duration of non-weightbearing following open reduction and internal fixation (ORIF) of ankle fractures (2). We previously reviewed a 2024 study by Bretherton and colleagues, which found that initiating weight-bearing at two weeks post-ORIF produced outcomes comparable to standard 6-week immobilization (3).

This study is a recent randomized controlled trial by Lehtonen et al. from Tampere University Hospital (Finland), which investigated whether earlier weight-bearing (two weeks post-ORIF) provides superior outcomes to the conventional six-week casting approach. The study also monitored complications, with follow-up assessments extending to two years post-surgery.

Ankle fractures are the third most common fracture requiring hospitalization, with many requiring surgical fixation.
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Two weeks may represent the minimum safe period of immobilization after open reduction internal fixation, before initiating functional bracing whilst still improving patient comfort and reducing costs.

METHODS

  • This RCT included patients who had undergone ORIF for uni-, bi-, or trimalleolar ankle fractures.
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