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Do we have to keep patients in cast and prevent them weight-bearing following internal fixation of ankle fractures?

Department of Surgery

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Dr Ramy Khojaly No more applications being accepted Awaiting Funding Decision/Possible External Funding

About the Project

Currently, there is a lack of consensus in post-operative management regimes following ORIF of unstable fractures about the ankle leading to a wide variation in clinical practice. There is an evolving understanding that extended periods of immobilisation and limitation of weight-bearing lead to poorer outcomes. The traditional non-weight bearing cast immobilisation was born of a desire to prevent loss of fixation and this practice has continued in many centres. The purpose of the study is to investigate the safety and efficacy of immediate weight-bearing and ROM exercise regimes following ORIF of unstable ankle fractures with a particular focus on functional outcomes and complication rates.
MethodsThis is a pragmatic randomised-controlled multi-centre trial, comparing immediate weight-bearing and range of motion (ROM) exercise versus non-weight bearing and immobilisation, following open reduction and internal fixation (ORIF) of unstable adults ankle fractures. The primary outcome measure is the ankle function Olerud and Molander Score, secondary outcomes measures include; complication rate, ankle ROM, physical and mental health outcomes SF36, time needed to return to work and postoperative hospitalisation length.
DiscussionThe literature is contradicting when it comes to the assessment of weight-bearing regimens following ankle fracture fixation. Immediate weight-bearing following ankle fracture fixation has not been investigated extensively. This randomised-controlled multi-centre trial will help in formulating a widely accepted guideline for postoperative management of ankle fractures.

Trial registration: ’retrospectively registered’ ISRCTN - ISRCTN76410775 30/06/2019
FundingApply for funding for MD project.

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