Aims This study aimed to compare the outcomes of two different postoperative management approaches following surgical fixation of ankle fractures: traditional cast immobilization versus the Early Motion and Directed Exercise (EMADE) programme. Methods A total of 157 patients aged 18 years or older who underwent successful open reduction and internal fixation (ORIF) of Weber B (AO44B) ankle fractures were recruited to this randomized controlled trial. At two weeks post-surgical fixation, participants were randomized to either light-weight cast-immobilization or the EMADE programme, consisting of progressive home exercises and weekly advice and education. Both groups were restricted to non-weightbearing until six weeks post-surgery. The primary outcome was assessed using the Olerud-Molander Ankle Score (OMAS) questionnaire at 12 weeks post-surgery, with secondary measures at two, six, 24, and 52 weeks. Exploratory cost-effectiveness analyses were also performed. Results Overall, 130 participants returned their 12-week OMAS questionnaires. The mean OMAS was significantly higher in the EMADE group compared with the immobilized group (62.0 (SD 20.9) vs 48.8 (SD 22.5)), with a clinically meaningful mean difference of 13.2 (95% CI 5.66 to 20.73; p < 0.001). These differences were maintained at week 24, with convergence by week 52. No intervention-related adverse events, including instability, were reported. Conclusion The EMADE programme demonstrated an accelerated recovery compared to traditional six-week cast immobilization for those who have undergone ORIF surgery to stabilize Weber B (AO44B) ankle fractures. The study found the EMADE intervention to be safe.

中文翻译：

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踝关节骨折固定后早期运动和定向运动（EMADE）：一项实用的随机对照试验。


目的 本研究旨在比较踝关节骨折手术固定后两种不同术后管理方法的结果：传统石膏固定与早期运动和定向运动 (EMADE) 计划。方法 共有 157 名 18 岁或以上、成功接受 Weber B (AO44B) 踝关节骨折切开复位内固定 (ORIF) 的患者参与这项随机对照试验。手术固定后两周，参与者被随机分配接受轻量石膏固定或 EMADE 计划，其中包括渐进式家庭锻炼以及每周建议和教育。两组患者在术后六周之前都被限制不能负重。主要结果是在术后 12 周时使用 Olerud-Molander 踝关节评分 (OMAS) 问卷进行评估，并在术后 2、6、24 和 52 周进行次要测量。还进行了探索性成本效益分析。结果 总体而言，130 名参与者返回了为期 12 周的 OMAS 调查问卷。与固定组相比，EMADE 组的平均 OMAS 显着较高（62.0 (SD 20.9) vs 48.8 (SD 22.5)），具有临床意义的平均差异为 13.2（95% CI 5.66 至 20.73；p < 0.001） 。这些差异在第 24 周保持不变，到第 52 周趋于一致。没有报告与干预相关的不良事件，包括不稳定。结论 对于接受 ORIF 手术稳定 Weber B (AO44B) 踝关节骨折的患者来说，与传统的六周石膏固定相比，EMADE 计划可以加速康复。研究发现 EMADE 干预是安全的。