When should open reduction and internal fixation ankle fractures begin weight bearing? A systematic review

The objective of this paper was to review the literature to assess when open reduction and internal fixation ankle fractures should commence weight bearing for the best outcome. An electronic search was undertaken of the databases AMED, Cinahl, Embase, Medline (via Ovid), Pedro and Pubmed, from their inception to November 2005. References lists were scrutinised and a hand search was also performed. We included all English language, human subject, controlled clinical trials, comparing the effects of early against later weight bearing following open reduction and internal fixation of ankle fractures. Two reviewers independently assessed the methodological quality of the literature using the PEDro (Physiotherapy Evidence Database) scoring system. Five papers comprising of 366 ankle fractures were reviewed. Overall, there was no significant difference between commencing early, compared to later weight bearing in subjects following open reduction and internal fixation, when evaluated against function, pain, range of movement, radiological assessment, complications, and return to work. The evidence reviewed was generally poor, with numerous methodological design limitations. The literature suggested that were was little difference between encouraging early or delayed weight bearing after open reduction and internal fixation of ankle fractures. Neither early nor later weight bearing significantly improves or jeopardises outcomes. However, due to the plethora of methodological limitations and limited evidence, it is not possible to reference this conclusion with conviction. Further large, well-designed randomized controlled trials are required to evaluate this area.