***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: In a prospect i ve , r and omized study , 30 patients were evaluated after ankle fracture treated by means of open reduction and internal fixation . The patients were r and omized to either postoperative immobilization in a plaster cast for 6 weeks or early mobilization ( 1–2 weeks after surgery ) in an ankle brace . Both regimens allowed weightbearing . Evaluation after 10 weeks and after 12 months included clinical assessment and isokinetic muscle strength measurements . Patients with impaired ankle function , as shown by means of an ankle score at 12 months , were followed for 3 years . At 10 weeks , impaired muscle torque and restricted range of motion was found on the affected side . This impairment was significantly less in the brace group . At 12 months , range of motion of the ankle and subtalar joints was restored , but dorsiflexion was still better in the brace group . Score values from a functional score did not correlate with muscle strength The effect of early mobilization and unrestricted weight bearing on final ankle motion in 51 operatively stabilized ankle fractures was prospect ively investigated . Patients were treated with an ankle-foot orthosis ( AFO ) or a cast . Full weight bearing was unrestricted in both groups . Thirty-two fractures received an AFO and 19 received a cast . The follow-up period ranged from 2.3 to 66 months , with a median of eight months . At the final follow-up examination , the motion in the AFO-treated group was not functionally different from that of the cast-treated group . However , 72 % of the patients treated in an AFO compared with 37 % of patients treated in a cast had ankle dorsiflexion greater than 15 degrees ( p = 0.014 ) . No complications were directly related to the AFO . No loss of reduction occurred in any patient . The results of this series indicate that early motion of a fractured ankle treated operatively does not affect ankle motion . Early motion was not associated with increased morbidity or loss of reduction We r and omised prospect ively 60 consecutive patients who were undergoing internal fixation of similar fractures of the ankle into two groups , one of which was treated by immobilisation in a below-knee cast and the other by a functional brace with early movement . All were instructed to avoid weight-bearing on the affected side . They were seen at 6 , 12 , 26 and 52 weeks . The functional rating scale of Mazur et al was used to evaluate the patients at each follow-up and we recorded the time of return to work . After one year the patients completed the SF-36 question naire . By then 55 patients remained in the study , 28 ( mean age 45.5 years ) in group 1 and 27 ( mean age 39.5 years ) in group 2 . Those in group 2 had higher functional scores at each follow-up but only at six weeks was this difference significant ( p = 0.02 ) . They also had higher mean SF-36 scores , but this difference was significant only for two of the eight aspects investigated . For patients gainfully employed , not on workers ' compensation , the mean time from surgery to return to work was 53.3 days for group 2 and 106.5 days for group 1 ; this difference was significant ( p = 0.01 ) . No patient developed a problem with the wound or had loss of fixation . Our findings support the use of a functional brace and early movement after surgery for fractures of the ankle Fifty-three patients with dislocated lateral malleolar fractures were r and omly selected after operation for either active ankle movement and weight bearing in an orthosis or no ankle movement but weight bearing in a walking cast . At follow-up examinations after three , six , and 18 months , no differences were found between the groups except for a better linear analogue scale result at three months for the orthosis group . Active ankle movements do not improve the rehabilitation of surgically treated lateral malleolar fractures In a prospect i ve , r and omised study , 27 patients with internally fixed ankle fractures were treated post-operatively for a period of six weeks by application of either a new dynamic vacuum orthosis with permitted mobilisation to 10 ° –0 ° –10 ° at the ankle joint or a synthetic cast . Full weight bearing was allowed in both groups after two weeks . The cast group was prescribed four weeks of physiotherapy following six weeks of immobilisation . After ten weeks , the Olerud and Mol and er score showed a significant difference in favour of the orthosis  . Early functional outcomes were significantly better for this group after six weeks and ten weeks . Patients in the orthosis group who were in formal employment  returned to work 24 days earlier than those in the  control group . Treatment of the orthosis patients took up three to four times less working time for the medical personnel . A saving of 38 euros on directly ascertainable costs could be evaluated . Rehabilitation of ankle fractures with a dynamic vacuum orthosis leads to better early functional results and greater patient satisfaction . The orthosis fulfils the conditions for early return to work . Treatment with an orthosis not only reduces working time for medical personnel but economises on expenditure for treatment and rehabilitation . RésuméUne étude r and omisée a été réalisée chez 27 patients présentant une fracture de la cheville et traités sur une période de six semaines soit par une orthèse dynamique permettant une mobilisation de 10 ° dans chaque secteur soit par une immobilisation plâtrée . Une marche avec appui complet a été autorisée dans les deux groupes , après 15 jours . Le groupe des patients plâtrés a bénéficié de 4 semaines de rééducation après six semaines d’immobilisation . Après 10 semaines , le score d’Olerud et de Mol and er montre une différence significative dans les résultats en faveur de l’orthèse . En effet , le devenir fonctionnel de ces patients a été de façon significative bien meilleur pour ce groupe après six semaines et après dix semaines . Ces patients sont retournés au travail 24 jours plus tôt que dans le groupe contrôle . Le traitement par orthèse permet d’économiser 38 euros et du temps médical . La rééducation de la fracture des chevilles grâce à l’orthèse dynamique permet un résultat fonctionnel excellent et relativement rapide . Cette orthèse met les patients dans de bonnes conditions pour un retour précoce à l’emploi , ce traitement permet également d’économiser le travail des médecins et permet également de faire des économies sur le temps de rééducation BACKGROUND AND PURPOSE The goal of this investigation was to study the recovery of ankle plantar-flexor peak torque , fatigue resistance , and functional ability ( stair climbing , walking ) following cast immobilization in patients with ankle fractures . SUBJECTS The participants were 10 patients who underwent open reduction-internal fixation and 8 weeks of cast immobilization following a fracture of the ankle mortise and 10 age- and sex-matched , noninjured comparison subjects . METHODS  Plantar-flexor torque and fatigue resistance were measured at 1 , 5 , and 10 weeks of rehabilitation using an isokinetic dynamometer .  Ankle plantar-flexor peak torque and fatigue resistance were correlated to timed ambulation , timed stair climbing , and unilateral heel-rises . RESULTS Following immobilization , plantar-flexor peak torque was decreased at all angular speeds and positions . The decrease in peak torque was associated with an increase in fatigue resistance . With rehabilitation , ankle plantar-flexor torque and fatigue resistance normalized . Regression analysis revealed a strong relationship between plantar-flexor peak torque and functional measures . By 10 weeks post-immobilization , peak torque , fatigue resistance , and all measures of functional performance had returned to control levels . CONCLUSION AND DISCUSSION The decrease in muscle performance , functional ability , and fatigue resistance induced by 8 weeks of cast immobilization can be reversed with 10 weeks of supervised physical therapy . In addition , this study demonstrated that ankle-plantar flexor torque is a good predictor of stair-climbing and walking performance in patients with ankle fractures Background : The aim of operative treatment for ankle fractures is to allow early movement after internal fixation . The hypothesis of this study was that early mobilization would improve functional recovery in patients after surgery for ankle fractures . Methods : In a prospect i ve r and omized controlled study , 66 consecutive patients with ankle fractures that required open reduction and internal fixation ( ORIF ) were assigned to one of two postoperative regimens : immobilization in a nonweightbearing below-knee cast or early mobilization in a removable cast .  Four patients were excluded from the study , leaving 62 for review . Results : Patients who had early mobilization in a removable cast had higher functional scores ( Olerud-Mol and er and AOFAS ) at 9 and 12 weeks postoperatively . They also returned to work earlier ( 67 days ) compared with those treated in nonweightbearing below-knee cast ( 95 days ) , p < 0.05 . There was no statistical difference in Quality of Life ( SF-36 Question naire ) at 6 months between the two groups . We had an approximately 10 % postoperative infection trend ( one superficial and two deep ) in the early mobilization group . Conclusion : Despite the overall short-term benefit of early mobilization , we had three patients in the early mobilization group who had wound complications . Both the surgeon and patient should be aware of the higher risk of wound complications associated with this treatment , and thus the accelerated rehabilitation protocol should be individualized In a prospect i ve r and omized trial the early functional results after immobilisation in a cast were compared to those after using a vacuum stabilizing system . The vacuum stabilizing system Vacoped offers equivalent stability compared to a plaster cast . In contrast to the cast the Vacoped can be removed for body care and physical therapy . Additionally the range of motion for dorsal flexion/extention in the upper ankle joint can be adjusted . From 9/1996 to 7/1997 there were 40 patients included in the study with an operated ankle fracture as monotrauma . Six weeks postoperatively the patients with cast treatment showed significantly higher functional deficits for the upper ankle joint ( 20 % ) , the lower ankle joint ( 40 % ) and muscle atrophy ( 2.1 cm side difference ) than the group with the vacuum stabilizing system ( upper ankle joint 15 % , lower ankle joint 25 % , 1.4 cm muscle atrophy ) . Five patients out of the group with the vacuum system were already at work three weeks postoperatively . Three months postoperatively the functional results for both groups were approximating . The vacuum stabilizing system Vacoped offers better early functional results than conventional cast treatment after osteo synthesis of ankle fractures . Because of the increased patient comfort and the early ability for physical therapy the vacuum stabilizing system is preferable to cast treatment Fifty-six patients who had a displaced fracture of the ankle necessitating surgical fixation were r and omly assigned to one of three postoperative treatment regimens : no plaster cast or weight-bearing , and active exercises of the ankle ; a non-weight-bearing plaster cast ; or a plaster walking cast for the first six postoperative weeks . At follow-up with a duration of as much as two years , there were no consistent differences in the clinical results between the three groups . The time lost from work and the proportion of excellent and good clinical results were also uninfluenced by the postoperative regimen . No adverse effects could be detected as a result of the patient 's having walked before the syndesmosis screw had been removed . It was concluded that none of the three postoperative regimens has any advantage over the others in a patient who has a stable osteo synthesis of a fracture of the ankle Background : Controversy continues with regard to the optimal postoperative care after open reduction and internal fixation of an ankle fracture . The hypothesis of this study was that postoperative treatment of an ankle fracture with a brace that allows active and passive range-of-motion exercises would improve the functional recovery of patients compared with that after conventional treatment with a cast . Thus , the purpose of this prospect i ve , r and omized study was to compare the long-term subjective , objective , and functional outcome after conventional treatment with a cast and that after use of functional bracing in the first six weeks following internal fixation of an ankle fracture . Methods : One hundred patients with an unstable and /or displaced Weber type-A or B ankle fracture were treated operatively and then were r and omly allocated to two groups : immobilization in a below-the-knee cast ( fifty patients ) or early mobilization in a functional ankle brace ( fifty patients ) for the first six postoperative weeks . The follow-up examinations , which consisted of subjective and objective ( clinical , radiographic , and functional ) evaluations , were performed at two , six , twelve , and fifty-two weeks and at two years postoperatively . Results : There were no perioperative complications in either study group , but eight patients who were managed with a cast and thirty-three patients who were managed with a brace had postoperative complications , which were mainly related to wound-healing . Two patients in the group treated with a cast had deep-vein thrombosis . All fractures healed well in both groups . The difference between the two groups with respect to the complication rate was significant ( p = 0.0005 ) . No significant differences between the study groups were observed in the final subjective or objective ( clinical ) evaluation . At the two-year follow-up examination , the average score ( and st and ard deviation ) according to the ankle-rating scale of Kaikkonen et al. was 85 ± 9 points for the group treated with a cast and 83 ± 10 points for the group treated with a brace , and the average ankle score according to the system of Olerud and Mol and er was 87 ± 8 points and 87 ± 9 points , respectively . Conclusions : The long-term functional outcome 
    Output:
    
Deep surgical site infection ( Peto odds ratio = 7.08 ; 95 % confidence interval : 1.39 , 35.99 ; P = .02 ; I(2 ) = 0 % ) , superficial surgical site infection , fixation failure , and reoperation to remove metalwork were more common after early ankle movement compared to immobilization .
The effects of early movement after ankle surgery on short-term functional outcomes are unclear , but there is no observable difference in the longer term .
There is a small reduction in risk of postoperative thromboembolism with early ankle movement .
Current evidence suggests that deep and superficial surgical site infections , fixation failure , and the need to remove metalwork are more common after early ankle movement .