Characteristics and effectiveness of postoperative rehabilitation strategies in ankle fractures

23 June 2022

What is the research about?

Ankle fractures are a common and costly health care presentation.  Postsurgical rehabilitation interventions for these injuries vary, with no international consensus, leading to fragmented communication between treating clinicians and consumers. We aimed to detail the specific characteristics of published postoperative rehabilitation strategies and the effectiveness of these strategies.

What did the researchers do?

We systematically reviewed literature from the past 10 years. Quality of the included studies was assessed using the National Heart, Lung and Blood Institute’s Study Quality Assessment Tools. A narrative synthesis was used to examine findings of the data extracted from the included studies.

What did the researchers find?

55 studies were included in the review. Of all 55 studies, eight were good quality (15%), 21 of fair quality (38%), and 26 of poor quality (47%). Forty studies described postoperative rehabilitation strategies without evaluating effectiveness while 15 focused on evaluating effectiveness. The characteristics of postoperative rehabilitation strategies varied widely and there was often not enough detail to replicate the protocols or implement the protocol into clinical practice. In particulary, a variety of definitions around the timeframes and/or magnitude of the load for weight-bearing were inconsistently used.  Late weight-bearing was the most common postoperative approach reported. However, evidence suggests that prescribing early weight-bearing does not impact patient safety, and may have advantages including the ability to carry out daily activities sooner.

How can you use this research?

To progress research comparisons and clinical practice around postoperative strategies for ankle fractures, we propose that weight-bearing is defined as “early’ if instituted two weeks from the date of surgery and “late” if instituted six weeks or later. This will assist with the more consistent terminology used in trials and provide clear guidence to clinicians. Based on current evidence early weight-bearing should be used in clinical practice as it potentially improves short-term outcomes without appearing to compromise long-term outcomes.


This was a collaborative research project supported by the Jamieson Trauma Institute, a collaboration of Metro North Hospital and Health Service and the Motor Accident Insurance Commission, and RECOVER Injury Research Centre, a collaboration of The University of Queensland and the Motor Accident Insurance Commission, Queensland, Australia.

About the researchers

Dr Melanie Plinsinga is an early career researcher with particular interest in exercise management and rehabilitation.

A/Prof Silvia Manzanero is at Research Coordinator for the Jamieson Trauma Institute. Her research  strives to advance trauma prevention, research, systems, and clinical management

A/Prof Venerian Johnston has qualifications in physiotherapy, occupational health and safety and work disability prevention. Her research is focused on improving work participation for those with compensable musculoskeletal injuries.

Dr Nicole Andrews is an occupational therapist and internationally recognised scholar in the field of pain management.

Dr Panos Barlas is a qualified physiotherapist with expertise in musculoskeletal rehabilitation.

Dr Victoria McCreanor is a health economist interested in generating evidence for value-based healthcare policies.


Plinsinga, M, Manzanero, S.,  Johnston, V.,  Andrews, N., Barlas, P., McCreanor, V.  Characteristics and effectiveness of postoperative rehabilitation strategies in ankle fractures: a systematic review, Journal of Orthopaedic Trauma. Published ahead of print. doi: 10.1097/BOT.0000000000002436


Trauma, Ankle Fracture, Postsurgical, Rehabilitation, Weight-bearing, Physiotherapy

Contact information 

Dr Nicole Andrews
Twitter: @Nic_Em_Andrews