Early Unprotected Weight Bearing and Pre-Scheduled Supervised Rehabilitation Program after Surgical Treatment of Ankle Fractures

Ankle fractures represent one of the most common orthopedic injuries in the lower extremity. Weightbearingand rehabilitation protocols after surgical treatment of ankle fracture have recently evolved from traditionalmethods to full weight-bearing protocols. However, more evidence is needed on unprotected immediate weight-bearingalong with a standardized rehabilitation program. The purpose of this study was to evaluate effects of unprotectedimmediate weight-bearing as tolerated and an eight-week prescheduled supervised rehabilitation program on the midtermclinical and functional outcomes of surgically treated ankle fractures, and to compare functional results with theunaffected side. Eighty patients (24F and 56M) who underwent rigid fixation of bimalleolar ankle fractures were included(mean age 41.57±13.22 years). Preoperative radiographs and computed tomography scans were used to evaluateand classify the fractures. The fractures were classified using Lauge-Hansen classification system. Ankle ROMs, PainDisability Index (PDI), American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scores, and Short Form-36 scores were evaluated. Patients were allowed unprotected weight-bearing on the immediate postoperative periodand a standardized supervised prescheduled rehabilitation program was undertaken following surgery. The mean follow-up period was 30.32±6.91 months. Based on Lauge-Hansen classification, supinationexternalrotation injuries were found in 32(40%) patients, supination adduction injuries in 14(17.4%) patients, pronationexternalrotation injuries in 28(35%) patients, and pronation-abduction fractures in 6(7.6%) patients. The solid unionwas achieved in all patients at the final follow-up. The mean PDI score was 12.78±14.78, and the AOFAS score was80.93±17.24. Although patients’ health-related quality of life was at a good level, the injured-side ankle ROM was lowerthan the healthy side (P≤ 0.05). Satisfactory clinical and functional outcome can be achieved at mid-term with unprotected weight-bearingas tolerated and pre-scheduled supervised eight-week rehabilitation program following rigid internal fixation of anklefractures. However, this protocol is not studied in patients with associated comorbidities.Level of evidence: III