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Safety of early weightbearing after ankle fracture fixation

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Patients with surgically treated ankle fractures are traditionally kept non-weightbearing for at least six weeks post-operatively; however, recent literature suggests numerous benefits of early weightbearing (EWB) before six weeks without significantly impacting long-term outcomes. This study aims to review the safety of early vs late weightbearing following ankle fracture fixation by assessing the complication rate.

Methods

This was a single-centre retrospective study. Between 2020 and 2023, all ankle fixations that commenced weightbearing at two weeks were added to the EWB group. An equal number of similar patients with six-week non-weightbearing were added to the late weightbearing (LWB) group. Baseline characteristics, risk factors, types of fractures and any complications in the six-month post-operative period were evaluated from these cohorts.

Results

In total, 459 ankle fixations were identified of which 87 patients met the criteria for the EWB group, with a further 87 added to the LWB group. There was no significant difference in age between the two groups (51.7 ± 20.1 vs 51.0 ± 15.5, respectively; p = 0.81), but more female patients and diabetics in the EWB group. Fracture types were similar between both cohorts (p = 0.51). Complication rate in the EWB group was not significantly different to the LWB group (5 vs 9, p > 0.05).

Conclusion

No increase in complication rate was identified by commencing weightbearing early at two weeks after ankle fixation compared to six weeks. We therefore suggest EWB if appropriate, given its associated benefits including restoration of patient independence and improved quality of life.

Level of evidence

Therapeutic, Level IV.

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Funding

This work received no specific grant from any funding agency in the public, commercial or not-for profit sectors.

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Authors and Affiliations

  1. Department of Trauma & Orthopaedics, West Hertfordshire Teaching Hospital NHS Trust, Hertfordshire, UK

    Russell de Sa, Nikki Shah, Benjamin Rudge & Edmund Ieong

Authors
  1. Russell de Sa
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  2. Nikki Shah
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  3. Benjamin Rudge
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  4. Edmund Ieong
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by RdS and NS. The first draft of the manuscript was written by RdS, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Russell de Sa.

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Conflict of interests

Non-financial interests: EI is one of the orthopaedic consultant foot and ankle surgeons who operated on patients of the early weightbearing group. He was not involved in the collection or analysis of data.

Ethical approval

This study was registered with the local audit department of our Trust as part of an evaluation of our orthopaedic service. It followed local protocols for data collection, analysis and presentation, and ethical committee review was not required for this work as per local policy.

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de Sa, R., Shah, N., Rudge, B. et al. Safety of early weightbearing after ankle fracture fixation. Eur J Orthop Surg Traumatol 34, 1003–1007 (2024). https://doi.org/10.1007/s00590-023-03758-w

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  • DOI: https://doi.org/10.1007/s00590-023-03758-w

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