IMMEDIATE VERSUS DELAYED WEIGHT BEARING FOLLOWING ANKLE OPEN REDUCTION AND INTERNAL FIXATION: A PILOT RANDOMIZED CONTROLLED TRIAL

Introduction Immediate weight bearing (IWB) following ankle fracture fixation may accelerate functional recovery, but concerns regarding safety have limited its routine use. This randomised controlled trial (RCT) pilot study evaluated the feasibility and early functional outcomes of IWB compared with delayed weight bearing at six weeks (DWB) after open reduction and internal fixation (ORIF). Methods Thirty patients with stable ankle fractures after ORIF were randomised (IWB n = 15; DWB n = 15). Primary outcome was the Self- Reported Foot and Ankle Score (SEFAS) at three months. Secondary outcomes included Olerud-Molander Ankle Score (OMAS), time to full weight bearing, and time to return to pre-injury activities. Results At three months, mean SEFAS and OMAS scores were higher in the IWB group (35.8 and 66.9) compared with DWB (31.1 and 57.1), respectively. The median time to full weightbearing and pre-injury activities was 24 and 65 days in the IWB group, and 59 and 74 days in the DWB group, respectively. Discussion In this pilot trial, Immediate weight bearing after ankle ORIF was associated with earlier recovery milestones and improved patient- reported outcomes at three months compared with delayed weight bearing. Conclusion: This pilot trial has demonstrated the safety of early weight bearing post ankle ORIF with improved early functional outcomes. These findings support the feasibility of a larger multicentre RCT to confirm clinical benefit and inform postoperative rehabilitation protocols. Lessons learned from this pilot on patient screening and enrollment will be invaluable in doing so.