Very early prescription of range of motion exercises in ankle fractures treated with ORIF does not increase the rate of complications and reoperations: A survival risk analysis

Lionel Llano; Juan Ignacio Theaux; Nehuen Forti; Victoria Barbaglia; Danilo Taype; Carlos Sancineto; Guido Carabelli; Jorge Barla

doi:10.1016/j.injury.2023.111019

Very early prescription of range of motion exercises in ankle fractures treated with ORIF does not increase the rate of complications and reoperations: A survival risk analysis

Injury. 2023 Nov:54 Suppl 6:111019. doi: 10.1016/j.injury.2023.111019.

Authors

Lionel Llano¹, Juan Ignacio Theaux², Nehuen Forti², Victoria Barbaglia², Danilo Taype², Carlos Sancineto², Guido Carabelli², Jorge Barla²

Affiliations

¹ Trauma Section, Instituto de Ortopedia y Traumatología "Carlos E. Ottolenghi" Hospital Italiano de, Buenos Aires, Argentina. Electronic address: lionel.llano@hospitalitaliano.org.ar.
² Trauma Section, Instituto de Ortopedia y Traumatología "Carlos E. Ottolenghi" Hospital Italiano de, Buenos Aires, Argentina.

PMID: 38143111
DOI: 10.1016/j.injury.2023.111019

Abstract

Background: Ankle fractures are commonly treated with non-surgical or surgical (preferably ORIF) approaches based on fracture characteristics. The postoperative care regimens vary widely, and the impact of very early mobilization on complications and reoperation rates in ankle fractures treated with ORIF remains unclear.

Methods: A retrospective analysis was conducted on ankle fractures treated between January 2014 and November 2020. Demographic and fracture characteristic data were collected. Very early prescription of range of motion exercises was defined as initiation within the first week after surgery, typically between the second and seventh postoperative day. Complications, reoperations, and time to these events were analyzed. Kaplan Meier survival analysis was performed to assess the risk of complications with very early mobilization.

Results: A total of 299 patients met the inclusion criteria. The cohort included 83 unimalleolar, 77 bimalleolar, and 138 trimalleolar fractures. Of the patients, 116 (38.8%) underwent very early range of motion. Complications occurred in 45 events among 39 patients (13%), with 16 events (41%) in the very early range of motion group. Reoperations were required for 23 patients (3.67% of the cohort). No statistically significant differences were found in the analysis of complications, with a hazard ratio (HR) of 1.17, and in the adjusted analysis with an HR of 1.12. Similarly, the reoperation analysis showed no significant differences, with an HR of 0.85 and 0.68 in the adjusted analysis.

Conclusion: Very early prescription of range of motion exercises in ankle fractures treated with ORIF is a safe approach, as it does not increase the rates of complications or reoperations compared to early or late mobilization. This study supports the use of very early mobilization as a rehabilitation method for ankle fractures.

Keywords: Ankle fractures; Complications, reoperations; Mobilization; Open reduction internal fixation (ORIF); Range of motion.

MeSH terms

Ankle Fractures* / surgery
Fracture Fixation, Internal / adverse effects
Fracture Fixation, Internal / methods
Humans
Range of Motion, Articular
Retrospective Studies
Risk Assessment
Survival Analysis
Treatment Outcome