{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T21:27:53Z","timestamp":1787952473147,"version":"build-2784847793"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec>\n            <jats:title>Objectives:<\/jats:title>\n            <jats:p>We studied the safety of immediate weight-bearing as tolerated (IWBAT) and immediate range of motion (IROM) after open reduction internal fixation (ORIF) of selected malleolar ankle fractures (defined as involving bony or ligamentous disruption of 2 or more of the malleoli or syndesmosis without articular comminution) and attempted to identify risk factors for complications.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design:<\/jats:title>\n            <jats:p>Retrospective case\u2013control study.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Setting:<\/jats:title>\n            <jats:p>Level 1 Urban Trauma Center and multiple community hospitals, orthopedic specialty hospitals, and outpatient surgicenters within one metropolitan area.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patients\/Participants:<\/jats:title>\n            <jats:p>Of 268 patients at our level 1 trauma center who underwent primary ORIF of a selected malleolar fracture from 2013 to 2018, we identified 133 (49.6%) who were selected for IWBAT and IROM. We used propensity score matching to identify 172 controls who were non\u2013weight-bearing (NWB) and no range of motion for 6 weeks postoperatively. The groups did not differ significantly in age, body mass index, Charleston Comorbidity Index, smoking status, diabetes status, malleoli involved, percentages undergoing medial malleolus (60.9% IWBAT vs. 51.7% NWB), posterior malleolus (24.1% IWBAT, 26.7% NWB), or syndesmosis fixation (41.4% IWBAT, 42.4% NWB, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.85).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Intervention:<\/jats:title>\n            <jats:p>IWBAT and IROM after ankle ORIF versus NWB for 6 weeks.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Main Outcome Measurements:<\/jats:title>\n            <jats:p>Postoperative complications, including delayed wound healing, superficial or deep infection, and loss of reduction.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>There was no significant difference in total complications (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.41), nonoperative complications (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.53), or operative complications, including a loss of reduction (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.89). We did not identify any factors associated with an increased complication risk, including posterior malleolus or syndesmosis fixation, diabetes, age, or preinjury-assisted ambulation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>We failed to demonstrate a difference in complications in general and loss of reduction in particular when allowing immediate weight-bearing\/ROM in selected cases of operatively treated malleolar fractures, suggesting this may be safe. Future prospective randomized studies are necessary to determine if immediate weight-bearing\/ROM is safe and whether it offers any benefits to patients with operatively treated malleolar fractures.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Level of Evidence:<\/jats:title>\n            <jats:p>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/bot.0000000000002003","type":"journal-article","created":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T22:00:14Z","timestamp":1605132014000},"page":"308-314","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":10,"title":["Immediate Weight-Bearing and Range of Motion After Internal Fixation of Selected Malleolar Fractures: A Retrospective Controlled Study"],"prefix":"10.1097","volume":"35","author":[{"given":"Brianna R.","family":"Fram","sequence":"first","affiliation":[{"name":"Thomas Jefferson University Department of Orthopaedic Surgery and the Rothman Orthopaedic Institute, Philadelphia, PA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan G.","family":"Rogero","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University Department of Orthopaedic Surgery and the Rothman Orthopaedic Institute, Philadelphia, PA; and"},{"name":"Lewis Katz School of Medicine at Temple University, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard","family":"Chang","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University Department of Orthopaedic Surgery and the Rothman Orthopaedic Institute, Philadelphia, PA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James C.","family":"Krieg","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University Department of Orthopaedic Surgery and the Rothman Orthopaedic Institute, Philadelphia, PA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven M.","family":"Raikin","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University Department of Orthopaedic Surgery and the Rothman Orthopaedic Institute, Philadelphia, PA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20250614","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.injury.2006.04.130","article-title":"Epidemiology of adult fractures: a review","volume":"37","author":"Court-Brown","year":"2006","journal-title":"Injury."},{"key":"R2-20250614","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1186\/s12891-018-2326-x","article-title":"Epidemiology of adult ankle fractures: 1756 cases identified in norrbotten county during 2009\u20132013 and classified according to AO\/OTA","volume":"19","author":"Juto","year":"2018","journal-title":"BMC Musculoskelet Disord."},{"key":"R3-20250614","doi-asserted-by":"crossref","first-page":"525","DOI":"10.3109\/17453674.2014.908340","article-title":"Incidence of fractures requiring inpatient care","volume":"85","author":"Somersalo","year":"2014","journal-title":"Acta Orthop."},{"key":"R4-20250614","doi-asserted-by":"crossref","first-page":"526","DOI":"10.3109\/17453678609014785","article-title":"Early weight bearing of malleolar fractures","volume":"57","author":"Ahl","year":"1986","journal-title":"Acta Orthop Scand."},{"key":"R5-20250614","doi-asserted-by":"crossref","first-page":"535","DOI":"10.3109\/17453678709146394","article-title":"Early weight bearing of displaced ankle fractures","volume":"58","author":"Ahl","year":"1987","journal-title":"Acta Orthop Scand."},{"key":"R6-20250614","doi-asserted-by":"crossref","first-page":"23","DOI":"10.2106\/00004623-198971010-00005","article-title":"Early postoperative weight-bearing and muscle activity in patients who have a fracture of the ankle","volume":"71","author":"Finsen","year":"1989","journal-title":"J Bone Joint Surg Am."},{"key":"R7-20250614","first-page":"360","article-title":"Immediate unprotected weight-bearing of operatively treated ankle fractures","volume":"73","author":"Gul","year":"2007","journal-title":"Acta Orthop Belg."},{"key":"R8-20250614","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1302\/0301-620X.78B3.0780395","article-title":"Postoperative treatment of internally fixed ankle fractures","volume":"78-B","author":"van Laarhoven","year":"1996","journal-title":"J Bone Joint Surg Br Vol."},{"key":"R9-20250614","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1097\/BOT.0000000000000572","article-title":"Early weightbearing and range of motion versus non-weightbearing and immobilization after open reduction and internal fixation of unstable ankle fractures: a randomized controlled trial","volume":"30","author":"Dehghan","year":"2016","journal-title":"J Orthop Trauma."},{"key":"R10-20250614","doi-asserted-by":"crossref","first-page":"205","DOI":"10.2106\/00004623-200302000-00004","article-title":"Use of a cast compared with a functional ankle brace after operative treatment of an ankle fracture. A prospective, randomized study","volume":"85","author":"Lehtonen","year":"2003","journal-title":"J Bone Joint Surg Am."},{"key":"R11-20250614","first-page":"152","article-title":"Early mobilization of ankle fractures after open reduction and internal fixation","author":"Cimino","year":"1991","journal-title":"Clin Orthop Relat Res."},{"key":"R12-20250614","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1097\/00003086-199403000-00025","article-title":"Early postoperative ankle exercise. A study of postoperative lateral malleolar fractures","volume":"300","author":"Hedstr\u00f6m","year":"1994","journal-title":"Clin Orthop Relat Res."},{"key":"R13-20250614","first-page":"10","article-title":"Shorter recovery can be achieved from using walking boot after operative treatment of an ankle fracture","volume":"7","author":"Amaha","year":"2017","journal-title":"Asia Pac J Sports Med Arthrosc Rehabil Technol."},{"key":"R14-20250614","doi-asserted-by":"crossref","first-page":"188","DOI":"10.2174\/1874325001509010188","article-title":"Functional comparison of immediate and late weight bearing after ankle bimalleolar fracture surgery","volume":"9","author":"A\u011fir","year":"2015","journal-title":"Open Orthop J."},{"key":"R15-20250614","doi-asserted-by":"crossref","first-page":"491976","DOI":"10.1155\/2015\/491976","article-title":"Immediate weight-bearing after ankle fracture fixation","volume":"2015","author":"Firoozabadi","year":"2015","journal-title":"Adv Orthop."},{"key":"R16-20250614","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1177\/107110079501600205","article-title":"Ankle performance after ankle fracture: a randomized study of early mobilization","volume":"16","author":"Tropp","year":"1995","journal-title":"Foot Ankle Int."},{"issue":"suppl 1","key":"R17-20250614","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/BOT.0000000000001063","article-title":"Fracture and Dislocation classification Compendium\u20142018","volume":"32","author":"Meinberg","year":"2018","journal-title":"J Orthop Trauma."},{"key":"R18-20250614","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1177\/1071100717709576","article-title":"Economic burden of inpatient admission of ankle fractures","volume":"38","author":"Stull","year":"2017","journal-title":"Foot Ankle Int."},{"key":"R19-20250614","doi-asserted-by":"crossref","first-page":"638","DOI":"10.2340\/16501977-2599","article-title":"Evidence-based rehabilitation therapy following surgery for (peri-)articular fractures: a systematic review","volume":"51","author":"Schnackers","year":"2019","journal-title":"J Rehabil Med."},{"key":"R20-20250614","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/j.ocl.2013.06.005","article-title":"Weight bearing after a periarticular fracture: what is the evidence?","volume":"44","author":"Haller","year":"2013","journal-title":"Orthop Clin North Am."},{"key":"R21-20250614","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1186\/s13063-015-0714-1","article-title":"Weight bearing or non-weight bearing after surgically fixed ankle fractures, the WOW! study: study protocol for a randomized controlled trial","volume":"16","author":"Briet","year":"2015","journal-title":"Trials."},{"key":"R22-20250614","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/j.injury.2019.02.014","article-title":"Syndesmotic fixation in unstable ankle fractures: Does early post-operative weight bearing affect radiographic outcomes?","volume":"50","author":"Al-Hourani","year":"2019","journal-title":"Injury."},{"key":"R23-20250614","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.injury.2004.05.024","article-title":"Screw fixation of the syndesmosis: a cadaver model comparing stainless steel and titanium screws and three and four cortical fixation","volume":"36","author":"Beumer","year":"2005","journal-title":"Injury."},{"key":"R24-20250614","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.foot.2013.05.002","article-title":"Early weight-bearing in operatively fixed ankle fractures: a systematic review","volume":"23","author":"Black","year":"2013","journal-title":"Foot."},{"key":"R25-20250614","doi-asserted-by":"crossref","first-page":"666","DOI":"10.3113\/FAI.2009.0666","article-title":"Early mobilization of operatively fixed ankle fractures: a systematic review","volume":"30","author":"Thomas","year":"2009","journal-title":"Foot Ankle Int."},{"key":"R26-20250614","doi-asserted-by":"crossref","first-page":"e0118320","DOI":"10.1371\/journal.pone.0118320","article-title":"Weight-bearing and mobilization in the postoperative care of ankle fractures: a systematic review and meta-analysis of randomized controlled trials and cohort studies","volume":"10","author":"Smeeing","year":"2015","journal-title":"PLoS One."},{"key":"R27-20250614","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1097\/01.bot.0000197701.96954.8c","article-title":"Functional treatment and early weightbearing after an ankle fracture: a prospective study","volume":"20","author":"Simanski","year":"2006","journal-title":"J Orthop Trauma."},{"key":"R28-20250614","doi-asserted-by":"crossref","first-page":"302","DOI":"10.3109\/17453678809149368","article-title":"Mobilization after operation of ankle fractures. good results of early motion and weight bearing","volume":"59","author":"Ahl","year":"1988","journal-title":"Acta Orthop Scand."},{"key":"R29-20250614","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1177\/1071100714552823","article-title":"The effect of ankle joint immobilization on lower limb venous flow","volume":"36","author":"Craik","year":"2015","journal-title":"Foot Ankle Int."},{"key":"R30-20250614","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1097\/BOT.0000000000000245","article-title":"A prospective randomized multicenter trial comparing clinical outcomes of patients treated surgically with a static or dynamic implant for acute ankle syndesmosis rupture","volume":"29","author":"Laflamme","year":"2015","journal-title":"J Orthop Trauma."},{"key":"R31-20250614","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1097\/BOT.0000000000001559","article-title":"Improved reduction of the tibiofibular syndesmosis with TightRope compared with screw fixation: results of a randomized controlled study","volume":"33","author":"Sanders","year":"2019","journal-title":"J Orthop Trauma."}],"container-title":["Journal of Orthopaedic Trauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/BOT.0000000000002003","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,14]],"date-time":"2025-06-14T19:02:35Z","timestamp":1749927755000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/BOT.0000000000002003"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6]]},"references-count":31,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1097\/bot.0000000000002003","relation":{},"ISSN":["0890-5339"],"issn-type":[{"value":"0890-5339","type":"print"}],"subject":[],"published":{"date-parts":[[2021,6]]},"assertion":[{"value":"2020-11-02","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}