A Prospective Randomized Trial to Assess Early versus Delayed Weight Bearing Following Operatively Treated Ankle Fractures in the United States.

Authors

William T Obremskey, Kristin R Archer, Greg E Gaski, Ida Leah Gitajn, Roman M Natoli, Clay A Spitler, Joseph F Levy, Richard E Thompson, Elizabeth Wysocki, Lisa Reider

Published in

Journal of orthopaedic trauma. Oct 14, 2026. Epub Oct 14, 2026.

Abstract

To determine the safety of early versus delayed weight bearing and effectiveness for improving return-to-work following ankle fracture repair.
Design: Prospective randomized study.
19 United States Trauma Centers.
Adult patients (≥18 years) with ankle fracture (OTA/AO 44 A, B or C) undergoing surgical fixation were included. Open Gustilo-Anderson (G-A) Type IIIB, IIIC, syndesmotic injuries with fixation, and injuries with arterial impaction that surgeons felt unsafe to weight were excluded.
The co-primary outcomes were (1) non-inferiority of early versus delayed weight bearing for reoperation for complications of hardware failure, non-union, loss of reduction, infection, or fusion; and (2) gated superiority of early versus delayed weight bearing for time to return-to-work, both within 365 days of randomization. Reoperation and time to return-to-work was compared between patients assigned to early (2 weeks post-operatively) versus delayed (6 weeks post-operatively) weight bearing.
The modified intent to treat sample included 418 patients enrolled between January 2020 through October 2023; 214 early (mean age: 47; SD (15) range (18-84); 35% male); 204 delayed (mean age: 43; SD (15); 36% male). Reoperation for complication occurred in 5 early (2.3%, 95% Confidence Interval (CI): 0.3%, 4.4%), and 7 delayed patients (3.4%, 95% CI: 0.9%, 5.9%). Median time to return-to-work (95% CI) was 54 (42, 77) days and 69 (47, 89) days for the early and delayed groups, respectively. Early weight bearing was non-inferior to delayed weight bearing for reoperation (difference in complication free survival (early - delayed): 1.5 percentage points; 90% two sided CI: -1.7%, 4.8% which excluded the non-inferiority tolerance of -5.0%) and not superior for return-to-work (Hazard Ratio 1.1, 95% CI: 0.8, 1.6, p=0.475).
Trial findings add to the growing evidence demonstrating the safety of early weight bearing after fixation of bimalleolar and trimalleolar ankle fracture without syndesmotic disruption, a key concern for both clinicians and patients. However, no statistically significant benefit of earlier return-to-work was found.
I.

PMID:
42873990
Bibliographic data and abstract were imported from PubMed on 15 Oct 2026.

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