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What are the most effective rehabilitation interventions for ankle fractures in adults?
In comparing early versus delayed weight-bearing after surgical fracture management, early weight-bearing (within 3 weeks of surgery) probably resulted in a small improvement in activity limitation (ankle function) but the difference was not clinically important. There was no or very little impact on quality of life, participant satisfaction, pain and adverse events.
For removable versus non-removable ankle support, removable support after surgery may improve ankle function and health-related quality of life, though these differences were again small and may not be clinically important. For non-surgical fracture management, there was little difference between support types.
Lastly, the effectiveness of physical therapy interventions compared with usual care was uncertain due to very-low-certainty evidence and variability across studies.
The majority of participants were adults aged under 65, with no studies specifically targeting interventions for older adults over 65, who are a key demographic for ankle fractures. Additionally, most participants underwent surgical management, with only a few studies including those who received non-surgical treatment, limiting the generalisability of the findings to non-surgical cases.
An ankle fracture is a common lower limb injury often caused by twisting, falls or sports activities. Incidence rates vary but are increasing, particularly among older people.
Although immobilising the ankle acts to support and protect the fracture site during the early stages of healing, it also raises the risk of weakness, stiffness and lingering pain. Rehabilitation from these injuries focuses on restoring mobility and strength, beginning during or after initial treatment, with protocols sometimes recommending early weight-bearing and exercise.
Lewis SR, et al. Rehabilitation for ankle fractures in adults. Cochrane Database Syst Rev 2024;9:CD005595. This review contains 53 trials, which included 4489 people.
Pharmacist prescribers Linda Bryant and Leanne Te Karu discuss positive polypharmacy for heart failure. Current evidence shows the intensive implementation of four medications offers the greatest benefit to most patients with heart failure, with significant reductions in cardiovascular mortality, heart failure hospitalisations and all-cause mortality
