Results of Early Versus Delayed Weight Bearing Following Bimalleolar Ankle Fracture Fixation: A Systematic Review

Background and Purpose: For ankle fractures, a clear consensus exists on the criteria for surgical intervention. In sharp contrast, significant controversy surrounds the ideal post-operative protocol, regarding when patients should commence full weight-bearing and ankle range of motion exercises. Aim: This systematic study seeks to evaluate the outcomes of early versus delayed weight-bearing protocols in patients over 16 years old who have undergone surgical fixation for bimalleolar ankle fractures. Methods: A systematic literature search was operated across four electronic databases (Cochrane, Web of Science, Scopus, PubMed), supplemented by a review of different sources from incorporated articles and relevant systematic reviews. The inclusion criteria targeted both randomized and non-randomized controlled trials that compared early and late weight-bearing following ORIF of the ankle. The literature search was conducted from 2010 to December 2024, and we selected studies on these bases: Studies encompassed instances with or without syndesmotic damage, which were stabilized when present utilizing quadricortical transfixation screws. Individuals with polytrauma, open fractures, compromised skin integrity, osteoporosis, diabetes mellitus, ischemic heart disease, or peripheral vascular disease were excluded. The primary mechanism of injury was a twisting trauma. Results: Our findings indicate that the union rate remained high across the assessed studies, with no instances of malunion, delayed union, reoperation, or implant failure. The early weight bearing group reported less pain and stiffness, reflecting faster recovery, with comparable bone alignment in both groups. .Conclusion: Based on our findings, we found that early weight-bearing after ankle fracture surgery is safe, with no risk of malunion or implant failure. It promotes faster recovery to full weight-bearing and better functional outcomes than delayed approaches. Overall, it is a reliable method to enhance recovery while maintaining healing integrity. Keywords: Ankle fractures, Bimalleolar, late weight-bearing, early weight-bearing.