Early weight-bearing effective for recovery and cost in ankle fracture patients: Study

A new study published in The Lancet journal found an early weight-bearing method to be both extremely likely to be cost-effective and clinically non-inferior to the present standard of treatment (delayed weight-bearing).

The patients with fractured ankles are often told not to walk for 6 weeks following surgery (delayed weight-bearing). Early weight-bearing (walking) two weeks post-surgery may be a safer and better rehabilitation approach. In order to examine the clinical and financial efficacy of an early weight-bearing method vs a delayed weight-bearing strategy, Christopher Patrick Bretherton and colleagues undertook this study.

This pragmatic, randomised, multicenter, non-inferiority trial included 561 participants (over 18 years) who underwent acute surgery in 23 NHS hospitals in the UK for an unstable ankle fracture. The participants were randomly assigned to an early weight-bearing rehabilitation strategy (n = 281) or a delayed weight-bearing rehabilitation strategy (n = 280). Excluded patients were those receiving treatment for a hindfoot nail, those without protective ankle feeling (such as peripheral neuropathy), those incapable of giving informed permission, and those unable to follow study protocols. The therapy was not concealed from either the subjects or the doctors. The Olerud and Molander Ankle Score (OMAS), which measures ankle function in the per-protocol population 4 months after randomization, was the main outcome. The intention-to-treat population underwent superiority testing in the event of non-inferiority, and the pre-specified non-inferiority OMAS margin was –6 points.