Immediate Weight-Bearing Compared with Non-Weight-Bearing After Operative Ankle Fracture Fixation: Results of the INWN Pragmatic, Randomized, Multicenter Trial.

作者：R. Khojaly, Fiachra E Rowan, V. Shah, M. Nagle, M. Shahab, A. Ahmad, Darren Dahly, C. Taylor, R. M. Niocaill, May Cleary · 发表于：Journal of Bone and Joint Surgery. American volume · 年份：2025 · DOI：10.2106/jbjs.24.00965 · 被引用次数：16 · 研究领域：Medicine

BACKGROUND There has been weak consensus and a paucity of robust literature with regard to the best postoperative weight-bearing and immobilization regime for operatively treated ankle fractures. This trial compared immediate protected weight-bearing (IWB) with non-weight-bearing (NWB) with cast immobilization following ankle fracture fixation (open reduction and internal fixation [ORIF]), with a particular focus on functional outcomes, complication rates, and cost utility. METHODS This INWN (Is postoperative Non-Weight-bearing Necessary?) study was a prospective, pragmatic, randomized controlled trial (RCT), with participants allocated in a 1:1 ratio to 1 of 2 parallel groups. IWB from postoperative day 1 in a walking boot was compared with NWB and immobilization in a cast for 6 weeks, following ORIF of all standard types of unstable ankle fractures. Skeletally immature patients and patients with tibial plafond fractures were excluded. The type of surgical fixation was at the surgeon's discretion. Patients were randomized postoperatively by an operating room nurse using computerized block randomization (20 patients per block). Surgeons were blinded until after the operation. The study was multicenter and included 2 major orthopaedic centers in Ireland. Analysis was performed on an intention-to-treat basis. The primary outcome was the functional outcome assessed by the Olerud-Molander Ankle Score (OMAS) at 6 weeks. A cost-utility analysis via decision tree modeling was perf...