Get up and get moving! Minnesota-based TRIA Orthopaedic Center is telling ankle fracture patients that they have the green light to put weight on their affected joints as soon as they’re comfortable—even days after surgery.
Fernando Peña, M.D. is an orthopedic surgeon and foot and ankle specialist at TRIA. In the April 14, 2016 news release he stated, “Ankle fractures create a disruption in a patient’s life when they are unable to walk or participate in recreational activities after surgery. When I began noticing patients hop off the exam table at six weeks after surgery and walk out of the room, even with weight-bearing restrictions, this made me question the rehabilitation process following ankle fracture surgery. It’s times like this that show I’m continually learning from my patients.”
Under the TRIA Institute Outcomes Program, patients were allowed to bear weight as tolerated immediately following ankle fracture surgery.
As indicated in the news release, “From January 2009 through November 2014, TRIA collected data on 400 patients undergoing surgery for ankle fracture. Of that total, 178 patients were weight-bearing as tolerated immediately. Those who were able to weight-bear as tolerated immediately showed signs of accelerated recovery, with little to no difficulty climbing stairs or taking part in recreational activities. Patients who were able to weight-bear immediately took an average of 2.6 weeks to resume walking as compared to the average recovery time of 5.6 weeks.”
Asked what he was surprised to find, Dr. Peña told OTW, “That patients are usually right. This initiative was highly fueled by the fact that patients were showing good results by taking care of themselves and not so much by following our recommendations and instructions. We are obligated as health care providers to listen and observe our patients closely. This is the perfect example of how watching our patients can help us, the providers, to be better at what we do and make progress in our field of expertise. Most amazing scientific discoveries were already in front of us. We were just fortunate enough to have a scientist who thought about it, watched it closely, and decided to pursue it. The discovery of penicillin, X-rays, and sterilization, among others, come to mind. On a much lesser scale, this initiative took place in a very similar way.”
Asked if he thinks this will change standard practice, Dr. Peña said, “I do. But this is not just my opinion; this has been backed up by many colleagues within the orthopedic field. This initiative represents a very drastic change in the care of ankle fractures (one of the most common fractures sustained by people), and it will require some further research and reinforcement from us to the providers to make the recommendation stick. I am positive than four years from now, ankle fracture care across the country will be drastically different because of our results. Very few things, if any, in medicine switch automatically and drastically. It is similar to changing the profile of a beach. One wave cannot do it, but many consecutive waves will make it happen.”
