Multicenter RCT comparing two rehab protocols after ORIF of unstable ankle fractures. One group started weightbearing and ankle ROM at 2 weeks; the other stayed non-weightbearing in a cast for 6 weeks. The question: does early loading speed return to work and improve function without compromising the fixation?
When you fix an unstable ankle fracture with a stable construct (lag screw plus plate, minimum three proximal and two distal screws), you can start weightbearing and ankle ROM at the 2-week visit.
This trial answered the central postoperative debate: does early loading risk the fixation? The answer is no. Zero fixation failures and zero losses of reduction across 110 patients, with no increase in wound complications or infection.
The payoff is better early ROM and function at 6 weeks, plus simpler aftercare for the patient. Return to work was unchanged, but a baseline imbalance favoring the cast group muddied that endpoint.
Note the eligibility boundaries: this applies to fractures with stable fixation and an intact or repaired syndesmosis. Syndesmotic injuries requiring fixation and large posterior malleolar fragments (>25%) were excluded, so do not extrapolate the protocol to them.
A practical bonus: prolonged casting tracked with far more hardware removal for plate irritation (19% vs 2%), arguing against routine 6-week immobilization.
Multicenter RCT comparing two rehab protocols after ORIF of unstable ankle fractures. One group started weightbearing and ankle ROM at 2 weeks; the other stayed non-weightbearing in a cast for 6 weeks. The question: does early loading speed return to work and improve function without compromising the fixation?
When you fix an unstable ankle fracture with a stable construct (lag screw plus plate, minimum three proximal and two distal screws), you can start weightbearing and ankle ROM at the 2-week visit.
This trial answered the central postoperative debate: does early loading risk the fixation? The answer is no. Zero fixation failures and zero losses of reduction across 110 patients, with no increase in wound complications or infection.
The payoff is better early ROM and function at 6 weeks, plus simpler aftercare for the patient. Return to work was unchanged, but a baseline imbalance favoring the cast group muddied that endpoint.
Note the eligibility boundaries: this applies to fractures with stable fixation and an intact or repaired syndesmosis. Syndesmotic injuries requiring fixation and large posterior malleolar fragments (>25%) were excluded, so do not extrapolate the protocol to them.
A practical bonus: prolonged casting tracked with far more hardware removal for plate irritation (19% vs 2%), arguing against routine 6-week immobilization.