Safety, efficacy of early weight-bearing and mobilization after ORIF for ankle fractures .
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2015;3(8):9PLoS One. 2015 Feb 19;10(2):e0118320.
A total of 25 studies (randomized controlled trials and cohort studies) were included in this systematic review and meta-analysis investigating mobilization and weight-bearing following open reduction and internal fixation of ankle fractures. The purpose of this study was to examine the effectiveness of different postoperative rehabilitation protocols. The results of this review found that early weight-bearing and active mobilization did not cause a significant increase in incidence of complications and accelerated patients’ return to work and daily activities.
Were the search methods used to find evidence (original research) on the primary question or questions stated?
Was the search for evidence reasonably comprehensive?
Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
Were the conclusions made by the author or authors supported by the data and or analysis reported in the overview?
How would you rate the scientific quality of this evidence?
Oui = 1
Incertain = 0,5
Non pertinent = 0
Non = 0
L'évaluation des critères de rapport permet d'évaluer la transparence avec laquelle les auteurs rapportent les caractéristiques méthodologiques et les caractéristiques de l'essai dans la publication. L'évaluation est divisée en cinq catégories qui sont présentées ci-dessous.
4/4
Introduction
4/4
Accessing Data
3/4
Analysing Data
4/4
Results
2/4
Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
L'indice de fragilité est un outil qui aide à l'interprétation des résultats significatifs, en fournissant une mesure de la force d'un résultat. L'indice de fragilité représente le nombre d'événements consécutifs qui doivent être ajoutés à un résultat dichotomique pour que le résultat ne soit plus significatif. Un petit nombre représente un résultat plus faible et un grand nombre un résultat plus fort.
Pourquoi cette étude était-elle nécessaire maintenant ?
Ankle fractures account for a number of visits to orthopaedic and fracture clinics, commonly occurring in sporting activities. A number of these injuries are treated surgically, particularly open reduction and internal fixation (ORIF), though there has been debate about optimal postoperative rehabilitation in these cases, with no conclusive standard of postoperative care. As a result, this systematic review and meta-analysis aimed to compare the efficacy and safety of current rehabilitative interventions used in patients who undergo ORIF for ankle fractures.
Quelle était la principale question de recherche ?
How effective and safe are current rehabilitative interventions following open reduction and internal fixation of ankle fractures?
- In total, 19 studies provided comparison between mobilization (ie. exercises) versus immobilization after ORIF, and 11 studies provided comparison between early weight-bearing and delayed weight-bearing after ORIF.
- In comparing mobilization versus immobilization postoperatively, no statically significant differences were noted in functional outcome through Olerud Molander score in the short- and long-term (9 studies: Short-term MD -6.88 [95%CI: -17.66, 3.91]; Long-term MD -1.05 [95% CI: -4.11, 2.00]) or incidence of complications (12 studies: RR 1.22 [95%CI: 0.60, 2.45]). Mobilization demonstrated significantly earlier return to work/ daily activities (7 studies: MD -20.76 days [95%CI -40.02, -1.50]).
- In comparing early weight-bearing versus delayed weight-bearing, early weight-bearing groups demonstrated a mean 20.62-day earlier to work/daily activities as compared with delayed weight-bearing, though the difference did not reach statistical significance (3 studies: [95%CI -42.46, 1.22]; p=0.06). The incidence of complications did not significantly differ between early and delayed weight-bearing (8 studies: RR 1.26 [95%CI 0.56, 2.85]).
- Sub-group analysis of studies which featured immediate weight-bearing as tolerated as the early weight-bearing group also demonstrated no significant differences in complication risk (2 studies: RR 0.69 [95%CI 0.28, 1.73]).
De quoi dois-je me souvenir en priorité ?
In rehabilitation after open reduction and internal fixation (ORIF) for ankle fracture, earlier return to work and daily activities was noted with exercise versus immobilization, as well as early weight-bearing versus delayed weight-bearing, though the latter did not reach statistical significance. No protocol demonstrated a significantly higher incidence of complications than its comparator. Short- and long-term functional outcome also appeared similar between exercise and immobilization protocols.
Comment cela affectera-t-il les soins prodigués à mes patients ?
The results this study suggest that exercise therapy, as opposed to immobilization, after ankle fixation surgery may facilitate an earlier return to activities without increasing the risk of complications. Early weight-bearing also does not appear to increase risk for complications when compared to delayed weight-bearing, with a trend toward to earlier return to activities. Given the ongoing trials currently being performed with respect to postoperative rehabilitation after ankle fracture fixation, a re-evaluation in the near future with the addition of ongoing and planned randomized controlled trials may further define the roles of different postoperative care methods as they pertain to patient outcome.
AVIS DE NON-RESPONSABILITÉ
Le contenu de cette page est fourni à titre d'information uniquement et n'est pas destiné à remplacer un avis médical, un diagnostic ou un traitement professionnel. Si vous avez besoin d'un traitement médical, demandez toujours l'avis de votre médecin ou rendez-vous au service des urgences le plus proche. Les opinions, croyances et points de vue exprimés par les individus sur le contenu de cette page ne reflètent pas les opinions, croyances et points de vue d'OrthoEvidence.
0 de 4 articles mensuels GRATUITS débloqués
