The effectiveness of early weight bearing and mobilisation in post-operative ankle open reduction internal fixation patients: a systematic literature review

Purpose: Whilst stable ankle fractures can be managed conservatively, unstable fractures are often treated with surgical intervention with Open Reduction Internal Fixation (ORIF). Traditional post-operative management strategies includes immobilisation and non-weight bearing, new research may indicate this is associated with poor outcomes. This systematic review aims to identify if different weight-bearing and mobilisation post-surgery protocols have positive outcomes on post-ORIF patients with secondary aims to review rates of infection. Methods: A systematic literature review was completed of randomised controlled trials identified through search strategies from of SPORTDiscuss, CINAHL, Gale OneFile: Health and Medicine, MEDLINE and OpenAIRE databases with the final search completed on the 16th of Feburary 2024. Inclusion criteria were as follows, published in 2000 or sooner, peer-reviewed journal articles and the study protocol is a randomised control trial, Furthermore all patients must have received an ankle ORIF procedure. . Quality appraisal was then completed on all included controlled trials using the PEDro scale. Data extraction was then manually performed by the author. Results: Four randomised controlled trials were included in this study. Amongst the four studies, two found statistically significant differences in favour of early weight bearing at six weeks for functional outcomes (P = 0.0007 and P = <0.001 respectively). Additionally one of the two studies that found effectiveness in early stage EWB also found significant differences in eight weeks (P = 0.002), 12 weeks (P = 0.004) and 12 months (P = 0.02) in the per-protocol analysis all in favour of EWB against NWB. The mean difference between the two groups was 4.4 (95% CI, 0.8-8.1) at the 12-month follow-up. The other included studies found no significant differences regarding functional outcomes at any time frame postoperatively. Conclusion(s): Based on the findings of the included literature there is some evidence to suggest that early weight-bearing post-ORIF has some effect in increasing functional outcome scores within the first six weeks. However long-term effects of early weight bearing appear to be minimal. Evidence suggests that early weight bearing does not have a significant effect on complications or rates of infection. Impact: With current evidence, it can be recommended that early weight bearing would result in better short-term outcome measures in those that underwent an ORIF operation with little complications