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Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2024, Number 6

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Acta Ortop Mex 2024; 38 (6)

Clinical-functional results in patients with Weber A and B fractures with early rehabilitation and early weight bearing protected with circular appliance immobilization

Barragán-Hervella R, Quiroz-Williams J, López-Soto R, Luna-Méndez M, Gaytán-Fernández S, Medellín-Pérez M, Barrios-López A, Palma-Jaimes A

Language: Spanish
References: 29
Page: 397-403
PDF size: 332.00 Kb.


ABSTRACT

Introduction: the post-surgical management of ankle fractures is still controversial, and there is no consensus on which rehabilitation regimen should be included as the best. The objective of the study was to describe the clinical and functional results of post-surgical patients with A/B Weber ankle fracture managed with early rehabilitation through early support and immobilization with circular appliance immobilization. Material and methods: prospective observational study of patients with postoperative Weber A and B ankle fractures, who were prescribed a program of early gradual weight-bearing and protected with a circular appliance and were compared with patients who did not receive weight-bearing. At three months, claudication when walking, proprioception, mobility ranges, degree of independence (Barthel), pain (VAS) and functionality (AOFAS) were evaluated. The analysis was performed with Fisher and t-Student. Statistically significant value was p < 0.05. Results: sixty-two patients with a mean age of 39.8 years were included; 11.3% had an ankle fracture type A and 88.7% had a type B ankle fracture according to the Weber classification. The weight-bearing group (group A) had greater ranges of motion than the group without weight-bearing (group B), although group A had greater pain compared to group B. In the functional assessment, group A obtained a higher score and the degree of independence was similar in both groups. Conclusions: protected weight-bearing and early mobilization of a surgically managed ankle fracture is a faster reintegration measure compared to support deferral program.


REFERENCES

  1. Viladot-Voegeli A. Anatomía funcional y biomecánica del tobillo y el pie. Rev Esp Reumatol. 2003; 30(9): 469-77.

  2. Ferrero J, Vega J, Dalmau-Pastor M. Anatomía de la sindesmosis tibioperonea. Mon Act Soc Esp Med Cir Pie Tobillo. 2019; 11: 3-9. doi: 10.24129/j.mact.1101.fs1905002.

  3. Dalmau-Pastor M, Malagelada F, Guelfi M, Vega J. Anatomía del tobillo. Rev Esp Artrosc Cir Articul. 2020; 27(1): 5-11. doi: 10.24129/j.reaca.27167.fs1910045.

  4. Makkozzay-Pichardo TH. Complicaciones de las fracturas de tobillo. Ortho-tips. 2006; 2(4): 262-9.

  5. Sous-Sánchez JO, Navarro-Navarro R, Navarro-García R, Brito-Ojeda E, Ruiz-Caballero JA. Clasificación de las fracturas de tobillo. Canar Méd Quir. 2011; 9(25): 49-53.

  6. Hanlon DP. Leg, ankle, and foot injuries. Emerg Med Clin North Am. 2010; 28(4): 885-905. doi: 10.1016/j.emc.2010.09.001.

  7. Zaragoza-Velasco K, Fernández-Tapia S. Ligamentos y tendones del tobillo: anatomía y afecciones más frecuentes analizadas mediante resonancia magnética. Anales de Radiología México. 2013; 12(2): 81-94.

  8. Whittle AP. Fractures of the lower extremity. In: Canale ST, Beaty JH (eds.). Campbell's operative orthopaedics. 11th ed. Philadelphia: Mosby; 2008. pp. 3117-46.

  9. Pyle C, Kim-Orden M, Hughes T, Schneiderman B, Kay R, Harris T. Effect of early weightbearing following open reduction and internal fixation of unstable ankle fractures on wound complications or failures of fixation. Foot Ankle Int. 2019; 40(12): 1397-402. doi: 10.1177/1071100719867932.

  10. Lampasona H. Fracturas de tobillo tratadas mediante osteosíntesis: evaluación de resultados. Rev Asoc Arg Ortop Traumatol. 1999; 65(1): 38-41.

  11. Yañez-Arauz JM, Arzac-Ulla IR, Fiorentini G, Yáñez-Arauz JM. Osteosíntesis de fractura de tobillo. Análisis evolutivo con carga precoz. Estudio preliminar. Rev Asoc Arg Ortop Traumatol. 2016; 81(2): 93-8. doi: 10.15417/507.

  12. Papachristou G, Efstathopoulos N, Levidiotis C, Chronopoulos E. Early weight bearing after posterior malleolar fractures: an experimental and prospective clinical study. J Foot Ankle Surg. 2003; 42(2): 99-104. doi: 10.1016/s1067-2516(03)70009-x.

  13. Bazarov I, Peace RA, Lagaay PM, Patel SB, Lyon LL, Schuberth JM. Early protected weightbearing after ankle fractures in patients with diabetes mellitus. J Foot Ankle Surg. 2017; 56(1): 30-3. doi: 10.1053/j.jfas.2016.09.010.

  14. BONE Collaborative. Weight-bearing in ankle fractures: an audit of UK practice. Foot (Edinb). 2019; 39: 28-36. doi: 10.1016/j.foot.2019.02.005.

  15. Krannitz KW, Fallat LM, Schwartz SM. Radiographic healing of conservative versus operative management of supination-external rotation II fractures in a smoking and premature weight-bearing population. J Foot Ankle Surg. 2007; 46(4): 218-22. doi: 10.1053/j.jfas.2007.02.002.

  16. Tan EW, Sirisreetreerux N, Paez AG, Parks BG, Schon LC, Hasenboehler EA. Early weightbearing after operatively treated ankle fractures: a biomechanical analysis. Foot Ankle Int. 2016; 37(6): 652-8. doi: 10.1177/1071100715627351.

  17. Smeeing DPJ, Briet JP, van Kessel CS, Segers MM, Verleisdonk EJ, Leenen LPH, et al. Factors associated with wound- and implant-related complications after surgical treatment of ankle fractures. J Foot Ankle Surg. 2018; 57(5): 942-7. doi: 10.1053/j.jfas.2018.03.050.

  18. Jansen H, Jordan M, Frey S, Holscher-Doht S, Meffert R, Heintel T. Active controlled motion in early rehabilitation improves outcome after ankle fractures: a randomized controlled trial. Clin Rehabil. 2018; 32(3): 312-8. doi: 10.1177/0269215517724192.

  19. Lorente A, Palacios P, Lorente R, Mariscal G, Barrios C, Gandía A. Orthopedic treatment and early weight-bearing for bimalleolar ankle fractures in elderly patients: quality of life and complications. Injury. 2020; 51(2): 548-53. doi: 10.1016/j.injury.2019.11.028.

  20. Peláez-Alfonso L, Reina E, Rangel C, Reyes OE, Herrera JM. Impacto de la rehabilitación precoz tras osteosíntesis con placa antideslizante en pacientes con fracturas de tobillo de tipo B de Weber. Rev Colomb Ortop Traumatol. 2015; 29(4): 123-30. doi: 10.1016/j.rccot.2016.03.005.

  21. Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013; 118(4): 934-44. doi: 10.1097/ALN.0b013e31828866b3.

  22. Smeeing DP, Houwert RM, Briet JP, Kelder JC, Segers MJ, Verleisdonk EJ, et al. Weight-bearing and mobilization in the postoperative care of ankle fractures: a systematic review and meta-analysis of randomized controlled trials and cohort studies. PLoS One. 2015; 10(2): e0118320. doi: 10.1371/journal.pone.0118320.

  23. Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol. 1989; 42(8): 703-9. doi: 10.1016/0895-4356(89)90065-6.

  24. Sharma T, Farrugia P. Early versus late weight bearing & ankle mobilization in the postoperative management of ankle fractures: a systematic review and meta-analysis of randomized controlled trials. Foot Ankle Surg. 2022; 28(7): 827-35. doi: 10.1016/j.fas.2022.03.003.

  25. King CM, Doyle MD, Castellucci-Garza FM, Nguyentat A, Collman DR, Schuberth JM. Early protected weightbearing after open reduction internal fixation of ankle fractures with trans-syndesmotic screws. J Foot Ankle Surg. 2020; 59(4): 726-8. doi: 10.1053/j.jfas.2020.01.003.

  26. Dehghan N, McKee MD, Jenkinson RJ, Schemitsch EH, Stas V, Nauth A, et al. Early weightbearing and range of motion versus non-weightbearing and immobilization after open reduction and internal fixation of unstable ankle fractures: a randomized controlled trial. J Orthop Trauma. 2016; 30(7): 345-52. doi: 10.1097/BOT.0000000000000572.

  27. Myers DM, Pulido SH, Forsting S, Umbel B, Taylor BC. Effect of early weight bearing on outcomes after open reduction and internal fixation of trimalleolar ankle fractures. Orthopedics. 2021; 44(3): 160-5. doi: 10.3928/01477447-20210104-04.

  28. Bando K, Takegami Y, Ando T, Sugino T, Sato T, Fujita T, et al. Early weight bearing and mobilization decrease perioperative complications in patients after ankle fracture; the retrospective multicenter (TRON group) study. J Orthop Sci. 2023; 28(3): 651-5. doi: 10.1016/j.jos.2022.03.002.

  29. Sernandez H, Riehl J, Fogel J. Do early weight-bearing and range of motion affect outcomes in operatively treated ankle fractures: a systematic review and meta-analysis. J Orthop Trauma. 2021; 35(8): 408-13. doi: 10.1097/BOT.0000000000002046.



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