Mike: Hello, I’m Mike Clarke, Podcast Editor for the Cochrane Library. Ankle fractures are one of the most common fractures of the lower limb and it’s important to have evidence on how to help people recover from them. There’s been a Cochrane Review of this since 2008 and the most recent update was published in September 2024. In this podcast, Sophie Degraeve from Symmetron, talks with new author, Chris Bretherton from the Blizard Institute at Queen Mary University of London in the UK, about the latest findings.

Sophie: Hello Chris. Thanks for giving us this opportunity to dive into this latest research.

Chris: Hello Sophie. Thanks for having me. It's great to be here.

Sophie: Ankle fractures are pretty common, right? Can you give us a quick rundown about them and how they’re treated?

Chris: Sure! Ankle fractures happen a lot, with around 80,000 each year in the UK. They can be treated with or without surgery, depending on how stable the fracture is. If the fracture is unstable, surgery is usually needed to set the bones correctly and help them heal.

Sophie: It sounds like rehab after surgery is really important. What did your review focus on in terms of rehabilitation?

Chris: We looked at the effects of different rehab methods after ankle fractures, whether they had been treated with surgery or without. We wanted to see how effective rehab methods are for things like how well the ankle works, patient quality of life, satisfaction and pain, and any problems that might arise.

Sophie: How much evidence did you find and have there been important additions since the last review in 2012?

Chris: We now have 53 studies with around 4500 adult patients. These include several new key studies, especially two large ones. One, by Professor Kearney in 2019, compared using plasters versus boots after an ankle fracture. Another, which I led here in the UK, was published in June 2024, and looked at when to start walking after ankle surgery.

Sophie: That sounds like great timing for this update. What are the main findings?

Chris: One key finding is that starting to walk within three weeks after surgery (early weight-bearing) seems to lead to slightly better ankle function than waiting six weeks, which has been the usual approach. Also, using removable ankle supports, like boots that allow some movement and exercise, rather than a rigid plaster, can help improve ankle function and quality of life.

Sophie: What about rehab methods such as physical therapy?

Chris: The evidence for physical therapy was less clear than that for early versus delayed weight-bearing or removable versus non-removable supports. This is because very different types of physical therapy were tested and the studies were small, which means that we can’t say for sure if one type of physical therapy was better than another.

Sophie: What about patient satisfaction and pain management?

Chris: It was hard to draw clear conclusions about these because the evidence was not very strong. For example, early weight-bearing and removable supports didn’t show a clear benefit in reducing pain or significantly improving patient satisfaction compared to other methods. However, from a practical point of view, patients generally seem to prefer being able to walk sooner rather than having to rely on crutches or other people. Similarly, most prefer to have the option and freedom to move their ankle if they want to.

Sophie: What do your findings mean for doctors and patients?

Chris: Our findings suggest that while early weight-bearing and removable supports might only make small improvements in ankle function, they seem to be safe. This means that rehab plans can be personalised and ultimately either strategy is fine. However, it’s worth remembering that complications such as infection or other problems do still occur - so patients and doctors need to look out for them and more research is needed to help them do that.

Sophie: To finish, what’s your main message about ankle fracture rehab?

Chris: The main takeaway is that it’s important for rehab plans to be personalised and based on the patient’s progress and comfort, but it’s reasonable for early weight-bearing and a removable support to be the default recommendation for patients after an ankle fracture. 

Sophie: Thank Chris for sharing these insights. How can people find out more?

Chris: Thank you for having me. It’s been a pleasure discussing our work. People can read the full review online by going to Cochrane Library dot com and typing “ankle fracture” in the search box to get a link to it.