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Meta-Analysis
. 2015 Feb 19;10(2):e0118320.
doi: 10.1371/journal.pone.0118320. eCollection 2015.

Weight-bearing and mobilization in the postoperative care of ankle fractures: a systematic review and meta-analysis of randomized controlled trials and cohort studies

Diederik P J Smeeing  1 , Roderick M Houwert  2 , Jan Paul Briet  3 , Johannes C Kelder  4 , Michiel J M Segers  5 , Egbert Jan M M Verleisdonk  3 , Luke P H Leenen  1 , Falco Hietbrink  1
Affiliations
Meta-Analysis

Weight-bearing and mobilization in the postoperative care of ankle fractures: a systematic review and meta-analysis of randomized controlled trials and cohort studies

Diederik P J Smeeing et al. PLoS One. .

Abstract

Purpose: To determine the effectiveness and safety of interventions used for rehabilitation after open reduction and internal fixation of ankle fractures.

Methods: A systematic review and meta-analysis was performed using both randomized trials and cohort studies. The effect of mobilization, weight-bearing, and unprotected weight-bearing as tolerated on postoperative recovery was compared using the Olerud Molander score, return to work/daily activities, and the rate of complications.

Results: A total of 25 articles were included. Ankle exercises resulted in earlier return to work and/or daily activities compared to immobilization (mean difference (MD) -20.76 days; 95% confidence interval (CI) -40.02 to -1.50). There was no difference in the rate of complications between exercises and immobilization (risk ratio (RR) 1.22; 95% CI 0.60 to 2.45) or between early and late weight-bearing (RR 1.26; 95%CI 0.56 to 2.85).

Interpretation: Results of this meta-analysis show that following ankle surgery, 1) active exercises accelerate return to work and daily activities compared to immobilization, 2) early weight-bearing tends to accelerate return to work and daily activities compared to late weight-bearing. Active exercises in combination with immediate weight-bearing may be a safe option.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Process from initial search to final inclusion of studies on postoperative care of ankle fractures.
A flowchart following the PRISMA guidelines of the search strategy.
Fig 2
Fig 2. Risk of bias assessment.
—indicates a high risk of bias; + indicates a low risk of bias;? indicates an unclear risk of bias.
Fig 3
Fig 3. Effect of mobilization; return to work/daily activities.
The mean difference (SD) on the return to work/daily activities is shown between the ankle exercises groups and the immobilization groups.
Fig 4
Fig 4. Effect of weight-bearing; return to work/daily activities.
The mean difference (SD) on the return to work/daily activites is shown between the early weight-bearing groups and the late weight-bearing groups.
See this image and copyright information in PMC

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