***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: Objective : Postoperative care for ankle fractures is generally 1 of 2 regimens : 1 ) functional treatment combined with early weightbearing ( EWB ) , or 2 ) immobilization in a cast/orthosis for 6 weeks without weightbearing ( 6WC ) . The objective of this study was 2-fold : 1 ) to follow a prospect i ve group treated with EWB as to long-term subjective and objective outcomes , and 2 ) to compare a subset of this group with a matched group of historic controls treated with 6WC . Design : Prospect i ve , clinical , cohort observation , and retrospective matched pair analysis . Setting : University hospital , level 1 trauma center . Patients : Forty-three patients ( 20 males ; mean age , 49 ± 14 years ) with operated Weber B/C fractures underwent EWB .  For comparison , 23 patients of this group were matched to a same number of historic controls with respect to age , gender , body mass index , and fracture type . Intervention : Open reduction and internal fixation ( ORIF ) using a 1/3-tubular-fibula-plate for the fibula , and malleolar screws for the medial malleolus fracture ( in cases with a bimalleolar ankle fracture ) followed by EWB or 6WC . Main Outcome Measurements : Olerud and Tegner scores at follow-up ( at least 12 months after surgery ) , time to full weightbearing , return to work , pain intensity ( numerical rating scale ( NRS ) ) , and hospital stay . Statistical comparisons were performed by using the Mann-Whitney U test or Fisher exact test ( P < 0.05 ) . Results : Patients with EWB were full weightbearing at 7 ± 3 weeks and returned to work at 8 ± 5 weeks after surgery . At follow-up ( mean , 20 ± 11 months after surgery ) , all EWB patients showed good results in the Olerud score ( 90 ± 13 points ) . Matched-pair analysis in 23 patients in each group revealed differences between EWB and 6WC groups for hospital stay ( mean , 10.8 ± 4.7 vs. 13.6 ± 6 days ; P = 0.12 ) , time to full weightbearing ( mean , 7.7 ± 3.1 vs. 13.5 ± 9.4 weeks ; P = 0.01 ) , and time until return to work ( mean 9.2 ± 5.5 vs. 10.8 ± 7 weeks ; P = 0.63 ) . No differences concerning pain intensities were observed ( EWB vs. 6WC : NRS = 1.9 vs. 1.7 ; P = 0.12 ) . At follow-up , Olerud scores were generally considered good for both groups ; however , mean values in EWB patients were slightly higher ( 87 ± 14 vs. 79 ± 19 points ; P = 0.25 ) . In both groups , the majority of patients reached their preinjury level of activity as demonstrated by Tegner scores . Conclusions : EWB patients tolerated earlier full weightbearing compared with 6WC patients , and there were no disadvantages with EWB compared with 6WC concerning hospital stay , pain intensities , time until return to work , and Olerud/Tegner Scores . Potential c and i date s for EWB are patients with a stable osteo synthesis of their fractured ankles as judged by the responsible surgeon , compliance , and high motivation 40 patients with dislocated bimalleolar and trimalleolar ankle fractures took part in this r and omized study . All ankles were operated on using cerclage , staples and pins . Active ankle movement with weight bearing in an orthosis was compared with active ankle movement without weight bearing using a dorsal splint . Stereophotogrammetric analysis showed small movements in the ankle mortise in both groups but conventional radiography revealed no fracture redislocation . The clinical results did not differ . This study was design ed as the second part of a consecutive project . In the first part , early and late weight bearing in a cast without ankle movements was compared ( Ahl et al. 1987b ) . In comparing the first and the second parts of the study , a small but significant increase in fracture instability was observed in the early motion group . No lasting superior clinical result was achieved by early ankle movement . After operation on dislocated bimalleolar ankle fractures , early postoperative weight bearing in a walking cast is recommended Fifty-one patients with dislocated lateral malleolar fractures took part in this prospect i ve r and omized study . Active ankle movements with weight bearing in an orthosis were compared with active ankle movements without weight bearing using a dorsal splint . By using cerclage , staples , and pins ( Cedell 1967 ) , an exact reconstruction of the ankle mortise was achieved in 44/51 ankles .  Radiographic and stereophotogrammetric analyses at 3 months showed no redislocation and only small movements in the ankle mortise . Better loaded dorsal flexion capacity at 3 months was found in the orthosis group . This study was design ed as the second part of a consecutive study . In the first part , early or late weight bearing without ankle exercises was compared ( Ahl et al. 1986 ) . The results from the two consecutive parts indicate that active ankle movements in combination with weight bearing facilitate and improve the rehabilitation following operation for an ankle fracture In a prospect i ve , r and omised trial of 81 patients with fractures of the ankle of AO types A , B and C we compared two regimes of postoperative management after internal fixation . The patients were mobilised either non-weight-bearing with crutches or weight-bearing in a below-knee walking plaster . We found a temporary benefit in subjective evaluation only ( 65 v 50 points , Mann-Whitney test , cft , p=0.02 ) for those with a below-knee walking plaster . There were no significant differences between the groups in the loaded dorsal range of movement ( 25 degrees v 23 degrees , Mann-Whitney test , cft , p = 0.16 ) or in the overall clinical result . Both treatments were considered to be satisfactory and their choice depends on the ability to mobilise non-weight-bearing , wound healing , the type of work and personal preference 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 Background Passive joint mobilisation is a technique frequently used by physiotherapists to reduce pain , improve joint movement and facilitate a return to activities after injury , but its use after ankle fracture is currently based on limited evidence . The primary aim of this trial is to determine if adding joint mobilisation to a st and ard exercise programme is effective and cost-effective after cast immobilisation for ankle fracture in adults . Methods / Design Ninety participants will be recruited from the physiotherapy departments of three teaching hospitals and r and omly allocated to treatment or control groups using a concealed procedure . All participants will perform an exercise programme . Participants in the treatment group will also receive joint mobilisation twice a week for four weeks . Blinded follow-up assessment s will be conducted four , 12 and 24 weeks after r and omisation . The primary outcome measures will be the Lower Extremity Functional Scale and the Assessment of Quality of Life . Secondary outcomes will include measures of impairments , activity limitation and participation . Data on the use of physiotherapy services and participants ' out-of-pocket costs will be collected for the cost-effective and cost-utility analyses . To test the effects of treatment , between-group differences will be examined with analysis of covariance using a regression approach . The primary conclusions will be based on the four-week follow-up data . Discussion This trial incorporates features known to minimise bias . It uses a pragmatic design to reflect clinical practice and maximise generalisability . Results from this trial will contribute to an evidence -based approach for rehabilitation after ankle fracture 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  
    Output:
    
Conclusion : It is difficult to conclude whether early motion is overall better or worse than cast immobilization .
The evidence suggests however that a young fit patient who needs to return to work may benefit from early motion of the ankle joint whereas a patient with poor skin or at risk of infection may be better treated in a cast after surgery .