Early Weightbearing and Mobilization Versus Non-Weightbearing and Mobilization in Unstable Ankle Fractures

NCT ID: NCT01196338

Last Updated: 2011-06-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

110 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-09-30

Study Completion Date

2012-06-30

Brief Summary

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The primary objective of the investigators randomized controlled trial is to determine if early protected weightbearing and ankle range of motion after surgical treatment (open reduction internal fixation - ORIF) for ankle fractures improves the rate of return to work and functional outcome compared to postoperative ankle immobilization in a non-weightbearing cast.

Detailed Description

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This is a randomized controlled trial comparing early weightbearing and mobilization VS immobilization and non-weightbearing after initial treatment of unstable ankle fractures.

The primary objective of our randomized control trial is to determine if early protected weightbearing and ankle range of motion post open reduction internal fixation (ORIF) for unstable ankle fractures improves the rate of return to work and functional outcome compared to postoperative ankle immobilization in a non-weightbearing cast.

Our secondary objective is to determine the rate of adverse events (wound healing, infection, hardware failure) with early weightbearing and ROM comparable to rates with traditional post-op ankle immobilization.

Conditions

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Ankle Injuries

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Non-weightbearing no ROM

Patients will be placed in a back slab post-op and will remain non-weight bearing with crutches with no range of motion for a total of 6 weeks.

After 6 weeks post-op, they will be placed in a boot orthosis and permitted to weight-bear as tolerated.

Group Type ACTIVE_COMPARATOR

non-weight bearing, no range of motion

Intervention Type BEHAVIORAL

* 0 weeks to 2 weeks: Posterior plaster slab or cast, non-weightbearing, crutches;
* At 2 week visit to clinic: Posterior plaster slab or cast removed, staples/stitches removed, BK fibreglass cast or other orthosis applied, with instructions to continue non-weightbearing;
* At 2 weeks to 6 weeks: Ankle remains immobile and non-weightbearing;
* After 6 weeks: Begin weightbearing as tolerated. Instructions for limited range of motion to be given, and wean from orthosis.

Early weight-bearing and ROM

Patients will be placed in a back slab post-operatively. At 2 weeks post op they will have the back slab removed and placed in a boot orthosis. At this time they will be permitted to weight-bear as tolerated and perform limited ankle range of motion exercises.

After 6 weeks post op they will start to wean from the boot orthosis.

Group Type EXPERIMENTAL

Early weight-bearing and range of motion exercises

Intervention Type BEHAVIORAL

* 0 weeks to 2 weeks: Posterior plaster slab or cast, non-weightbearing, crutches;
* At 2 week visit to clinic: Posterior plaster slab or cast removed, staples/stitches removed placed in orthosis, with instructions to be weightbearing as tolerated. Instructions for limited range of motion to be given;
* At 2 weeks to 6 weeks: Weightbearing as tolerated in orthosis, follow range of motion instructions;
* After 6 weeks: Instructions to continue weightbearing as tolerated, wean from orthosis.

Interventions

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Early weight-bearing and range of motion exercises

* 0 weeks to 2 weeks: Posterior plaster slab or cast, non-weightbearing, crutches;
* At 2 week visit to clinic: Posterior plaster slab or cast removed, staples/stitches removed placed in orthosis, with instructions to be weightbearing as tolerated. Instructions for limited range of motion to be given;
* At 2 weeks to 6 weeks: Weightbearing as tolerated in orthosis, follow range of motion instructions;
* After 6 weeks: Instructions to continue weightbearing as tolerated, wean from orthosis.

Intervention Type BEHAVIORAL

non-weight bearing, no range of motion

* 0 weeks to 2 weeks: Posterior plaster slab or cast, non-weightbearing, crutches;
* At 2 week visit to clinic: Posterior plaster slab or cast removed, staples/stitches removed, BK fibreglass cast or other orthosis applied, with instructions to continue non-weightbearing;
* At 2 weeks to 6 weeks: Ankle remains immobile and non-weightbearing;
* After 6 weeks: Begin weightbearing as tolerated. Instructions for limited range of motion to be given, and wean from orthosis.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Unilateral unstable ankle fracture requiring surgical stabilization
* Treatment within two weeks of injury
* Closed or low grade open ankle fracture (grade 1 and/or 2)
* Skeletally mature

Exclusion Criteria

* Skeletally immature
* Previous ipsilateral ankle surgery
* Bilateral ankle fractures or other major injuries that would affect recovery time
* Grade 3 open fractures
* Inability to co-operate with post-op protocol (advanced dementia, polytrauma patient)
* Non-ambulatory pre injury
* Tibial plafond fractures including articular impaction requiring elevation
* Syndesmosis injury requiring fixation
* Posterior Malleolus fracture - more than 25% of articular surface
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Orthopaedic Trauma Association

OTHER

Sponsor Role collaborator

Canadian Orthopaedic Foundation

OTHER

Sponsor Role collaborator

Künzli SwissSchuh

UNKNOWN

Sponsor Role collaborator

University of Toronto

OTHER

Sponsor Role lead

Responsible Party

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Sunnybrook Health Sciences Centre

Principal Investigators

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Richard Jenkinson, MD, FRCSC

Role: PRINCIPAL_INVESTIGATOR

Sunnybrook Health Sciences Centre

Hans Kreder, MD,MPH,FRCSC

Role: STUDY_CHAIR

Sunnybrook Health Sciences Centre

Locations

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Sunnybrook Health Sciences Centre

Toronto, Ontario, Canada

Site Status RECRUITING

St. Michael's Hopspital

Toronto, Ontario, Canada

Site Status RECRUITING

Countries

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Canada

Central Contacts

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Richard Jenkinson, MD, FRCS(C)

Role: CONTACT

416-480-6100 ext. 7052

Hans Kreder, MD,MPH,FRCSC

Role: CONTACT

416-480-6100 ext. 6816

Facility Contacts

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Richard Jenkinson, MD, FRCSC

Role: primary

416-480-6100 ext. 7052

Hans Kreder, MD,MPH,FRCSC

Role: backup

416-480-6100 ext. 6816

Niloofar Dehghan, BSc, MD

Role: primary

416-997-8735

Michael McKee, MD, FRCSC

Role: backup

416-864-5880

References

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Ahl T, Dalen N, Lundberg A, Bylund C. Early mobilization of operated on ankle fractures. Prospective, controlled study of 40 bimalleolar cases. Acta Orthop Scand. 1993 Feb;64(1):95-9. doi: 10.3109/17453679308994541.

Reference Type BACKGROUND
PMID: 8451961 (View on PubMed)

Ahl T, Dalen N, Selvik G. Ankle fractures. A clinical and roentgenographic stereophotogrammetric study. Clin Orthop Relat Res. 1989 Aug;(245):246-55.

Reference Type BACKGROUND
PMID: 2502344 (View on PubMed)

Cimino W, Ichtertz D, Slabaugh P. Early mobilization of ankle fractures after open reduction and internal fixation. Clin Orthop Relat Res. 1991 Jun;(267):152-6.

Reference Type BACKGROUND
PMID: 2044269 (View on PubMed)

Gul A, Batra S, Mehmood S, Gillham N. Immediate unprotected weight-bearing of operatively treated ankle fractures. Acta Orthop Belg. 2007 Jun;73(3):360-5.

Reference Type BACKGROUND
PMID: 17715727 (View on PubMed)

Egol KA, Dolan R, Koval KJ. Functional outcome of surgery for fractures of the ankle. A prospective, randomised comparison of management in a cast or a functional brace. J Bone Joint Surg Br. 2000 Mar;82(2):246-9.

Reference Type BACKGROUND
PMID: 10755435 (View on PubMed)

Honigmann P, Goldhahn S, Rosenkranz J, Audige L, Geissmann D, Babst R. Aftertreatment of malleolar fractures following ORIF -- functional compared to protected functional in a vacuum-stabilized orthesis: a randomized controlled trial. Arch Orthop Trauma Surg. 2007 Apr;127(3):195-203. doi: 10.1007/s00402-006-0255-x. Epub 2006 Dec 30.

Reference Type BACKGROUND
PMID: 17195934 (View on PubMed)

Lehtonen H, Jarvinen TL, Honkonen S, Nyman M, Vihtonen K, Jarvinen M. Use of a cast compared with a functional ankle brace after operative treatment of an ankle fracture. A prospective, randomized study. J Bone Joint Surg Am. 2003 Feb;85(2):205-11. doi: 10.2106/00004623-200302000-00004.

Reference Type BACKGROUND
PMID: 12571295 (View on PubMed)

Lin CW, Moseley AM, Refshauge KM. Rehabilitation for ankle fractures in adults. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD005595. doi: 10.1002/14651858.CD005595.pub2.

Reference Type BACKGROUND
PMID: 18646131 (View on PubMed)

Nilsson G, Jonsson K, Ekdahl C, Eneroth M. Outcome and quality of life after surgically treated ankle fractures in patients 65 years or older. BMC Musculoskelet Disord. 2007 Dec 20;8:127. doi: 10.1186/1471-2474-8-127.

Reference Type BACKGROUND
PMID: 18096062 (View on PubMed)

Obremskey WT, Brown O, Driver R, Dirschl DR. Comparison of SF-36 and Short Musculoskeletal Functional Assessment in recovery from fixation of unstable ankle fractures. Orthopedics. 2007 Feb;30(2):145-51. doi: 10.3928/01477447-20070201-01.

Reference Type BACKGROUND
PMID: 17323637 (View on PubMed)

Olerud C, Molander H. A scoring scale for symptom evaluation after ankle fracture. Arch Orthop Trauma Surg (1978). 1984;103(3):190-4. doi: 10.1007/BF00435553.

Reference Type BACKGROUND
PMID: 6437370 (View on PubMed)

Petrisor BA, Poolman R, Koval K, Tornetta P 3rd, Bhandari M; Evidence-Based Orthopaedic Trauma Working Group. Management of displaced ankle fractures. J Orthop Trauma. 2006 Jul;20(7):515-8. doi: 10.1097/00005131-200608000-00012.

Reference Type BACKGROUND
PMID: 16891946 (View on PubMed)

Shimamura Y, Kaneko K, Kume K, Maeda M, Iwase H. The initial safe range of motion of the ankle joint after three methods of internal fixation of simulated fractures of the medial malleolus. Clin Biomech (Bristol). 2006 Jul;21(6):617-22. doi: 10.1016/j.clinbiomech.2005.12.018. Epub 2006 Feb 24.

Reference Type BACKGROUND
PMID: 16500006 (View on PubMed)

Simanski CJ, Maegele MG, Lefering R, Lehnen DM, Kawel N, Riess P, Yucel N, Tiling T, Bouillon B. Functional treatment and early weightbearing after an ankle fracture: a prospective study. J Orthop Trauma. 2006 Feb;20(2):108-14. doi: 10.1097/01.bot.0000197701.96954.8c.

Reference Type BACKGROUND
PMID: 16462563 (View on PubMed)

Sondenaa K, Hoigaard U, Smith D, Alho A. Immobilization of operated ankle fractures. Acta Orthop Scand. 1986 Feb;57(1):59-61. doi: 10.3109/17453678608993217.

Reference Type BACKGROUND
PMID: 3083644 (View on PubMed)

Strauss EJ, Egol KA. The management of ankle fractures in the elderly. Injury. 2007 Sep;38 Suppl 3:S2-9. doi: 10.1016/j.injury.2007.08.005.

Reference Type BACKGROUND
PMID: 17723786 (View on PubMed)

van Laarhoven CJ, Meeuwis JD, van der WerkenC. Postoperative treatment of internally fixed ankle fractures: a prospective randomised study. J Bone Joint Surg Br. 1996 May;78(3):395-9.

Reference Type BACKGROUND
PMID: 8636173 (View on PubMed)

Vioreanu M, Dudeney S, Hurson B, Kelly E, O'Rourke K, Quinlan W. Early mobilization in a removable cast compared with immobilization in a cast after operative treatment of ankle fractures: a prospective randomized study. Foot Ankle Int. 2007 Jan;28(1):13-9. doi: 10.3113/FAI.2007.0003.

Reference Type BACKGROUND
PMID: 17257532 (View on PubMed)

Siddique Amir, Prasad C.V.R, O'Connor D. Early Active Mobilization Versus Cast Immobilization in Operatively Treated Ankle Fractures. European Journal of Trauma 2005 No4 (31): 398-400

Reference Type BACKGROUND

Kreder, Hans What is the Role of

Reference Type BACKGROUND

Other Identifiers

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Ankle

Identifier Type: -

Identifier Source: org_study_id

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