***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 STUDY DESIGN Prospect i ve inception cohort study of 62 consecutive patients seen in 2 orthopaedic clinics following ankle fracture . OBJECTIVES To investigate 4 putative predictors ( age , fracture classification , acute management  [ surgical or nonsurgical ] , and ankle dorsiflexion range of motion measured at the time of cast removal ) of outcome after ankle fracture and to develop simple predictive models of outcome after ankle fracture . BACKGROUND Ankle fracture is a common condition . However , few studies have investigated factors that predict outcome after ankle fracture . METHODS AND MEASURES Sixty-two consecutive subjects aged 17 or older with ankle fractures were recruited from 2 hospital orthopaedic clinics . Outcome measures recorded at 6 weeks and 6 months after cast removal included 2 functional question naires , patients ' ratings of global improvement , and a measure of ankle dorsiflexion . The predictive value of 4 variables selected a priori was analyzed using bivariate and stepwise multiple linear regression . RESULTS Ankle dorsiflexion and fracture classification predicted outcome 6 weeks and 6 months after cast removal for all outcome measures used ( P < .05 , r2 = 0.09 - 0.47 ) . Fracture management ( surgical or nonsurgical ) inconsistently predicted outcome at both 6 weeks and 6 months , and age did not predict outcome at either 6 weeks or 6 months after cast removal . The predictive models explain between 19 % and 58 % of the variance in outcomes 6 weeks after cast removal and 19 % to 52 % of the variance in outcomes 6 months after cast removal . CONCLUSION Ankle dorsiflexion measured at the time of cast removal and fracture classification are clinical ly significant predictors of outcome after ankle fracture ; however , much unexplained variation in outcomes still exists 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 Background Despite conflicting results after surgically treated ankle fractures few studies have evaluated the effects of different types of training programs performed after plaster removal . The aim of this study was to evaluate the effects of a 12-week st and ardised but individually suited training program ( training group ) versus usual care ( control group ) after plaster removal in adults with surgically treated ankle fractures . Methods In total , 110 men and women , 18 - 64 years of age , with surgically treated ankle fracture were included and r and omised to either a 12-week training program or to a control group . Six and twelve months after the injury the subjects were examined by the same physiotherapist who was blinded to the treatment group . The main outcome measure was the Olerud-Mol and er Ankle Score ( OMAS ) which rates symptoms and subjectively scored function . Secondary outcome measures were : quality of life ( SF-36 ) , timed walking tests , ankle mobility tests , muscle strength tests and radiological status . Results 52 patients were r and omised to the training group and 58 to the control group . Five patients dropped out before the six-month follow-up result ing in 50 patients in the training group and 55 in the control group . Nine patients dropped out between the six- and twelve-month follow-up result ing in 48 patients in both groups . When analysing the results in a mixed model analysis on repeated measures including interaction between age-group and treatment effect the training group demonstrated significantly improved results compared to the control group in subjects younger than 40 years of age regarding OMAS ( p = 0.028 ) , muscle strength in the plantar flexors ( p = 0.029 ) and dorsiflexors ( p = 0.030 ) . Conclusion The results of this study suggest that when adjusting for interaction between age-group and treatment effect the training model employed in this study was superior to usual care in patients under the age of 40 . However , as only three out of nine outcome measures showed a difference , the beneficial effect from an additional st and ardised individually suited training program can be expected to be limited . There is need for further studies to eluci date how a training program should be design ed to increase and optimise function in patients middle-aged or older . Trial Registration Current Controlled Trials OBJECTIVE The primary aim of this study was to determine the effectiveness and cost-effectiveness of adding manual therapy to a physiotherapy programme for ankle fracture . DESIGN Assessor-blinded r and omized controlled trial . PARTICIPANTS Ninety-four adults were recruited within one week of cast removal for isolated ankle fracture . Inclusion criteria were : they were able to weight-bear as tolerated or partial weight-bear , were referred for physiotherapy , and experienced pain . Ninety-one participants completed the study . METHODS Participants were r and omly allocated to receive manual therapy ( anterior-posterior joint mobilization over the talus ) plus a st and ard physiotherapy programme ( experimental ) , or the st and ard physiotherapy programme only ( control ) . They were assessed by a blinded assessor at baseline , and at 4 , 12 and 24 weeks . The main outcomes were activity limitation and quality of life . Information on costs and healthcare utilization was collected every 4 weeks up to 24 weeks . RESULTS There were no clinical ly worthwhile differences in activity limitation or quality of life between groups at any time-point . There was also no between-group difference in quality -adjusted life-years , but the experimental group incurred higher out-of-pocket costs ( mean between-group difference = AU$200 , 95 % confidence interval 26 - 432 ) . CONCLUSION When provided in addition to a physiotherapy programme , manual therapy did not enhance outcome in adults after ankle fracture 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 In a monocenter r and omized controlled trial , 45 patients with isolated malleolar fracture type OTA/AO 44 A1–B2 undergoing ORIF were allocated r and omly to a postoperative treatment either with a vacuum-stabilized orthesis with prescribed full weight bearing after the second week ( 23 patients ) ( orthesis group — OG ) or with functional aftertreatment with partial weight bearing of 15 kg for 6 weeks ( 22 patients ) ( control group — CG ) . Outcomes were compared at 6- and 10-week follow-up examinations . The Olerud and Mol and er ankle ( OMA ) score , ankle swelling , usage of crutches , range of motion , Short Form 12 , patient-reported visual analogue scales ( VAS ) ( pain , comfort , walking confidence ) and time to return to work were evaluated . All patients of OG showed reduced swelling at discharge . The median OMA scores after 6 weeks were 42 and 42.5 ( p = 0.46 ) and after 10 weeks 69 and 72 ( p = 0.55 ) in the OG and CG , respectively . The time to achieve secure walking capacity was reduced by 1 day ( p = 0.03 ) in the OG . After ORIF of simple malleolar fractures , patients with a vacuum-stabilized orthesis can bear full weight 2 weeks postoperatively . This group experienced no adverse events . Postoperative swelling was significantly reduced and of the ability to walk on stairs confidently was shorter as compared to a functional aftertreatment without any external stabilization of the ankle In the prospect i ve cohort study reported here , we used the Short Musculoskeletal Function Assessment ( SMFA ) question naire to assess rate of return of functional outcome after open reduction and internal fixation of unstable ankle fractures ( Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen [ OTA/AO ] 44B and 44C ) at a level II trauma center over the course of 1 year . The entire group of 69 consecutive adults improved significantly ( P<.01 ) on the SMFA Emotional Status and Dysfunction scales from 2 to 4 months and on the Mobility and Daily Activities scales from 2 to 4 months and from 4 to 6 months . There were no significant changes on the Arm/H and Function and Bother scales . There was a significant effect of age on Mobility , Daily Activities , and Dysfunction , with older patients ( > or = 50 years ) obtaining higher ( worse ) scores . There was no significant effect on patient sex on any of the scales . Patients with 44C fractures ( vs 44B fractures ) had significantly ( P = .05 ) higher mean Bother scores at 6 months . There were no significant differences arising from presence or absence of a fracture of the medial malleolus . Our SMFA data show that older 
    Output:
    
Studies with older participants and predominantly male participants tended to report worse functional outcomes .