Document Detail


Early mobilization of operatively fixed ankle fractures: a systematic review.
MedLine Citation:
PMID:  19589314     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: It is commonly believed that early motion after joint fixation is advantageous, especially in the upper limb. In the ankle joint this is much less clear. No previous systematic review of the evidence for this could be found in the literature.
MATERIALS AND METHODS: Nine randomized control trials were identified which met the inclusion criteria and compared early motion of the ankle joint to immobilization in a cast for 6 weeks. These varied in quality and numbers. All treated patients equally in all other respects including weight bearing. Where outcome measures were similar, some data pooling was possible.
RESULTS: There is good evidence that early motion is associated with a quicker return to work on average (p = 0.008) and also with an improved range of motion at 12 weeks (dorsiflexion p = 0.001; plantarflexion p < 0.00001) compared to cast immobilization. However it is also associated with an increased risk of wound infection (p = 0.002). There is a suggestion that early motion results in a lower rate of deep vein thrombosis (p = 0.12). There is no evidence that it results in improved joint specific outcome scores or range of motion at 1 year.
CONCLUSION: It is difficult to conclude whether early motion is overall better or worse than cast immobilization. The evidence suggests however that a young fit patient who needs to return to work may benefit from early motion of the ankle joint whereas a patient with poor skin or at risk of infection may be better treated in a cast after surgery.
Authors:
Gethin Thomas; Helen Whalley; Chetan Modi
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Foot & ankle international     Volume:  30     ISSN:  1071-1007     ISO Abbreviation:  Foot Ankle Int     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-07-10     Completed Date:  2009-10-08     Revised Date:  2014-08-27    
Medline Journal Info:
Nlm Unique ID:  9433869     Medline TA:  Foot Ankle Int     Country:  United States    
Other Details:
Languages:  eng     Pagination:  666-74     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Ankle Injuries / physiopathology,  rehabilitation*,  surgery*
Casts, Surgical
Early Ambulation*
Fracture Fixation*
Fractures, Bone / physiopathology,  rehabilitation*,  surgery*
Humans
Range of Motion, Articular
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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