To cast or not to cast? Postoperative care of ankle fractures: a meta-analysis of randomized controlled trials
Postoperative care of ankle fractures treated with open reduction and internal fixation (ORIF) is a debated topic. A meta-analysis of Randomized Controlled Trials was conducted with the aim of comparing early mobilization and weightbearing to traditional postoperative protocols. A systematic search...
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| Veröffentlicht in: | Musculoskeletal surgery 2024-12, Vol.108 (4), p.383-393 |
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| description | Postoperative care of ankle fractures treated with open reduction and internal fixation (ORIF) is a debated topic. A meta-analysis of Randomized Controlled Trials was conducted with the aim of comparing early mobilization and weightbearing to traditional postoperative protocols. A systematic search of electronic databases was conducted according to the PRISMA guidelines. Only randomized clinical trials were included. Data about clinical outcome, time to return to work and complications were extracted and summarized. Meta-analyses were performed. Twenty studies for a total of 1328 patients were included. Early mobilization was compared to immobilization in 724 patients: the two groups did not significantly differ in terms of short- and long-term clinical outcome (
p
= 0.08 and
p
= 0.41, respectively). However, early mobilization resulted to be significantly associated with faster return to work (
p
= 0.047). Early weightbearing was compared to nonweightbearing in 1088 patients. While the clinical difference between the two groups was not significant at short term (
p
= 0.08), it was significant at long term (
p
= 0.002). No other significant differences, in particular regarding complications, were highlighted between different groups. Early motion, early weightbearing and traditional postoperative protocols are all safe strategies after ORIF for unstable ankle fractures. Early mobilization is significantly associated with faster return to work and early weightbearing improves long term clinical outcome.
Level of evidence: I. |
| doi_str_mv | 10.1007/s12306-024-00832-2 |
| format | Article |
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p
= 0.08 and
p
= 0.41, respectively). However, early mobilization resulted to be significantly associated with faster return to work (
p
= 0.047). Early weightbearing was compared to nonweightbearing in 1088 patients. While the clinical difference between the two groups was not significant at short term (
p
= 0.08), it was significant at long term (
p
= 0.002). No other significant differences, in particular regarding complications, were highlighted between different groups. Early motion, early weightbearing and traditional postoperative protocols are all safe strategies after ORIF for unstable ankle fractures. Early mobilization is significantly associated with faster return to work and early weightbearing improves long term clinical outcome.
Level of evidence: I.</description><identifier>ISSN: 2035-5106</identifier><identifier>ISSN: 2035-5114</identifier><identifier>EISSN: 2035-5114</identifier><identifier>DOI: 10.1007/s12306-024-00832-2</identifier><identifier>PMID: 38805165</identifier><language>eng</language><publisher>Milan: Springer Milan</publisher><subject>Ankle ; Ankle Fractures - surgery ; Casts, Surgical ; Clinical outcomes ; Clinical trials ; Early Ambulation ; Fracture Fixation, Internal - methods ; Humans ; Medicine ; Medicine & Public Health ; Open Fracture Reduction - methods ; Orthopedics ; Postoperative Care - methods ; Postoperative period ; Randomized Controlled Trials as Topic ; Return to Work ; Review ; Surgical Orthopedics ; Treatment Outcome ; Weight-Bearing</subject><ispartof>Musculoskeletal surgery, 2024-12, Vol.108 (4), p.383-393</ispartof><rights>The Author(s), under exclusive licence to Istituto Ortopedico Rizzoli 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Istituto Ortopedico Rizzoli.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c1712-8c2c9c92b73b8f5f57517b10baba3697cfaa9dae9c3b92ab922b17b164958de93</cites><orcidid>0000-0002-4003-2387 ; 0000-0003-3992-9637 ; 0000-0002-6486-6300 ; 0000-0003-0867-1338 ; 0000-0001-9974-4787 ; 0000-0002-0819-1935 ; 0000-0003-4348-0983 ; 0000-0001-9279-4722 ; 0000-0001-7771-8676</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12306-024-00832-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s12306-024-00832-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38805165$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Barile, F.</creatorcontrib><creatorcontrib>Artioli, E.</creatorcontrib><creatorcontrib>Mazzotti, A.</creatorcontrib><creatorcontrib>Arceri, A.</creatorcontrib><creatorcontrib>Zielli, S. O.</creatorcontrib><creatorcontrib>Manzetti, M.</creatorcontrib><creatorcontrib>Viroli, G.</creatorcontrib><creatorcontrib>Ruffilli, A.</creatorcontrib><creatorcontrib>Faldini, C.</creatorcontrib><title>To cast or not to cast? Postoperative care of ankle fractures: a meta-analysis of randomized controlled trials</title><title>Musculoskeletal surgery</title><addtitle>Musculoskelet Surg</addtitle><addtitle>Musculoskelet Surg</addtitle><description>Postoperative care of ankle fractures treated with open reduction and internal fixation (ORIF) is a debated topic. A meta-analysis of Randomized Controlled Trials was conducted with the aim of comparing early mobilization and weightbearing to traditional postoperative protocols. A systematic search of electronic databases was conducted according to the PRISMA guidelines. Only randomized clinical trials were included. Data about clinical outcome, time to return to work and complications were extracted and summarized. Meta-analyses were performed. Twenty studies for a total of 1328 patients were included. Early mobilization was compared to immobilization in 724 patients: the two groups did not significantly differ in terms of short- and long-term clinical outcome (
p
= 0.08 and
p
= 0.41, respectively). However, early mobilization resulted to be significantly associated with faster return to work (
p
= 0.047). Early weightbearing was compared to nonweightbearing in 1088 patients. While the clinical difference between the two groups was not significant at short term (
p
= 0.08), it was significant at long term (
p
= 0.002). No other significant differences, in particular regarding complications, were highlighted between different groups. Early motion, early weightbearing and traditional postoperative protocols are all safe strategies after ORIF for unstable ankle fractures. Early mobilization is significantly associated with faster return to work and early weightbearing improves long term clinical outcome.
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Postoperative care of ankle fractures: a meta-analysis of randomized controlled trials</title><author>Barile, F. ; Artioli, E. ; Mazzotti, A. ; Arceri, A. ; Zielli, S. 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Only randomized clinical trials were included. Data about clinical outcome, time to return to work and complications were extracted and summarized. Meta-analyses were performed. Twenty studies for a total of 1328 patients were included. Early mobilization was compared to immobilization in 724 patients: the two groups did not significantly differ in terms of short- and long-term clinical outcome (
p
= 0.08 and
p
= 0.41, respectively). However, early mobilization resulted to be significantly associated with faster return to work (
p
= 0.047). Early weightbearing was compared to nonweightbearing in 1088 patients. While the clinical difference between the two groups was not significant at short term (
p
= 0.08), it was significant at long term (
p
= 0.002). No other significant differences, in particular regarding complications, were highlighted between different groups. Early motion, early weightbearing and traditional postoperative protocols are all safe strategies after ORIF for unstable ankle fractures. Early mobilization is significantly associated with faster return to work and early weightbearing improves long term clinical outcome.
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| ispartof | Musculoskeletal surgery, 2024-12, Vol.108 (4), p.383-393 |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Ankle Ankle Fractures - surgery Casts, Surgical Clinical outcomes Clinical trials Early Ambulation Fracture Fixation, Internal - methods Humans Medicine Medicine & Public Health Open Fracture Reduction - methods Orthopedics Postoperative Care - methods Postoperative period Randomized Controlled Trials as Topic Return to Work Review Surgical Orthopedics Treatment Outcome Weight-Bearing |
| title | To cast or not to cast? Postoperative care of ankle fractures: a meta-analysis of randomized controlled trials |
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