Comprehensive Systematic Review: Comparison of Early Mobilization Without Cast versus Traditional Cast Immobilization Following Open Reduction Internal Fixation (ORIF) of Lateral Malleolus Fractures

Wellyan Rahmat Adillio (Faculty of Medicine, University of Bengkulu)
Pramudya Akbar Bahari (Faculty of Medicine, University of Bengkulu)

Indonesian Journal of Advanced Research (IJAR)
Vol. 5 No. 9 (2026): September 2026

Ankle fractures are among the most frequently operatively treated injuries, yet optimal postoperative rehabilitation remains controversial. This PRISMA 2020 review included 25 reports (23 cohorts; 3,613 participants) comparing early mobilization without cast with cast immobilization after ORIF. Early mobilization significantly improved OMAS at 6–8 weeks (MD 9.42; 95% CI 4.80–14.03; p<0.0001) and 12 weeks–4 months (MD 6.12; 95% CI 2.28–9.96; p=0.0018), but the advantage disappeared by ≥12 months (MD 0.71; 95% CI -1.20 to 2.61; p=0.467), with significant temporal decay (β=-3.60; p=0.005). Range of motion, return to work, pre-injury activity, and short-term quality of life favored early mobilization, without significant increases in fixation failure/non-union or thromboembolism, although wound complications were numerically higher. Implant removal was significantly reduced (RR 0.10). Early mobilization therefore provides clinically meaningful short-term benefits during the first 3–4 months, with the advantage no longer detectable at one year.