Impact of Weight-Bearing and Early Mobilization in Patients After Internal Fixation of Unstable Ankle Fractures

Background: Optimal postoperative management of unstable ankle fractures after internal fixation remains unclear. Traditional care uses prolonged immobilization and delayed weight-bearing (DWB), but early mobilization may accelerate recovery. This study evaluated whether early weight-bearing (EWB) and mobilization improve functional outcomes, rehabilitation progress, and complication rates after surgical fixation. Methods: This randomized controlled trial included 52 adult patients (18-65 years) with acute unilateral unstable ankle fractures treated through open reduction and internal fixation. Participants were randomly allocated into 2 groups: (1) EWB and mobilization (initiated after 2 weeks of non-weight-bearing) and (2) DWB (continuing non-weight-bearing an additional 4 weeks). The primary outcomes were time to return to work, time to full weight-bearing, and functional recovery measured by the Olerud-Molander Ankle Score (OMAS). Secondary outcomes included range of motion (ROM), physiotherapy sessions, and complication rates. Both groups followed a standardized postoperative rehabilitation program; however, the EWB group commenced protected weight-bearing and physiotherapy at 2 weeks postoperatively, whereas the DWB group remained non-weight-bearing until 6 weeks, when physiotherapy began. Results: Patients in the EWB group demonstrated a faster return to work (41.38 ± 10.20 vs. 51.88 ± 6.18 days, p < 0.001) and required fewer physiotherapy sessions (85% needing <8 sessions vs. 11.5% in the control group, p < 0.001). Functional outcomes were superior in the EWB group, with significantly higher OMAS scores from 6 weeks onward (p < 0.001). ROM improved rapidly in the intervention group, showing significant differences at 6 weeks and persisting through 12 months (p < 0.001). Despite early mobilization, complication rates, including wound complications (3.8% vs. 7.7%, p = 0.552) and fixation failure, were comparable between groups. Conclusion: EWB and mobilization after internal fixation of unstable ankle fractures enhance functional recovery, accelerate rehabilitation, and reduce the time to return to daily activities without increasing complications. However, given the modest sample size and single-center design, these findings should be interpreted cautiously, and confirmation in larger studies is needed before routine adoption. Trial Registration: This study was retrospectively registered in the Iranian Registry of Clinical Trials (IRCT20201124049484N1). Level of Evidence: Level 1b (Individual Randomized Controlled Trial) according to OCEBM Levels of Evidence Working Group. "The Oxford 2011 Levels of Evidence." Oxford Centre for Evidence-Based Medicine. See Instructions for Authors for a complete description of levels of evidence.