It had become something of an open joke when Dr. Fernando Peña saw patients six weeks after surgeries for fractured ankles, and they pretended like they had stayed off their injured legs for the entire recovery period.
"They would hop off the bench and walk right out of the room," Peña said. "And I'd say, 'you've been walking!' "
Rather than scolding them, the ankle specialist at the TRIA orthopedic center in Bloomington decided in 2013 to roll with it. In study results presented to the American Academy of Orthopaedic Surgeons, Peña showed what happened over the past three years when 178 patients were allowed to put weight on their surgically repaired ankles as soon as they felt able, and 222 followed the standard protocol of using crutches and keeping their ankles immobilized for at least six weeks.
Turns out, the patients given more freedom were back to walking regularly in just less than 3 weeks — and one ridiculously ambitious 22-year-old was up and about four days after surgery. And these early walkers showed no higher rates of complications or need for follow-up surgeries because, as Peña described it, their reconstructed ankles "fell apart."
The study was specific to patients receiving open surgeries for the placements of screws or plates to reset and stabilize badly broken ankles.
Doctors for years have talked about whether to push such patients to walk as soon as possible, but Peña said improved orthopedic technology has made the prospect easier today. "We really like to mobilize things" as early as possible, he said, "because every time you don't use something, you're going to get stiffness, you're going to get atrophy."
Now, he recommends the walk-as-soon-as-you-are-able approach to all ankle surgery patients. Benefits include faster returns to work and daily activities. TRIA will continue to collect outcomes data on these patients to make sure the premise holds that they experience faster recoveries and no added complications.
Peña admitted to nerves when he started advising a test group of patients to walk when they felt able. The approach was done in the course of clinical care, rather than as an study that randomized the patients into two comparison groups.
One group was treated one way, and then all of the next group was treated the other way. "We took a chance," Peña said. "I have to confess and admit that, but it has worked out beautifully."