Early Motion and Directed Exercise (EMADE) following ankle fracture fixation: a pragmatic randomized controlled trial

Area of Science:

• Orthopedic surgery
• Rehabilitation medicine
• Clinical trial methodology

Background:

• Ankle fractures, particularly Weber B (AO44B) type, require effective postoperative management.
• Traditional cast immobilization is a common approach, but its efficacy compared to active rehabilitation is debated.

Purpose of the Study:

• To compare the functional recovery outcomes of the Early Motion and Directed Exercise (EMADE) programme versus traditional cast immobilization after surgical fixation of Weber B ankle fractures.

Main Methods:

• A randomized controlled trial involving 157 adult patients undergoing open reduction and internal fixation (ORIF) for Weber B ankle fractures.
• Participants were randomized at two weeks post-surgery to either cast immobilization or the EMADE program (progressive home exercises, weekly education).
• Both groups maintained non-weightbearing status for six weeks; the Olerud-Molander Ankle Score (OMAS) was the primary outcome at 12 weeks.

Main Results:

• The EMADE group showed a significantly higher mean Olerud-Molander Ankle Score (OMAS) at 12 weeks (62.0) compared to the immobilized group (48.8), indicating better functional recovery.
• This significant difference in OMAS was maintained at 24 weeks, with scores converging by 52 weeks.
• No adverse events related to the intervention, such as instability, were reported in either group.

Conclusions:

• The EMADE programme offers an accelerated and safe recovery pathway for patients with surgically treated Weber B ankle fractures compared to traditional six-week cast immobilization.
• Early, directed exercise and education can be a safe and effective alternative to prolonged casting post-ORIF surgery for ankle fractures.