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Today’s article “Early Weightbearing Versus Nonweightbearing After Operative Treatment of an Ankle Fracture A Multicenter, Noninferiority, Randomized Controlled Trial” from Park et al. comes from six centers in Seoul. 

Ankle fractures are one of the more common fractures orthopedic surgeons will encounter. Traditional teaching after fixation of an unstable ankle fracture included at least six weeks of nonweightbearing. Many more recent studies have challenged this teaching, showing that outcomes can be equivalent or improved with early weightbearing. 

This study’s main outcome was the Olerud-Molander ankle score (OMAS) at 12 month follow up. Some important patient population exclusions include those needing syndesmotic fixation as well as those with a BMI > 30. They included unstable lateral malleolus, medial malleolus, and bimalleolar fractures. Early weightbearing was defined as weightbearing beginning at 2 weeks postoperatively versus the delayed weightbearing group beginning at 6 weeks post op. 

The authors showed that the OMAS was not significantly different between the two groups at 1 year post op. There was no significant difference loss of reduction, implant failure, delayed or nonunion. Patients were very satisfied or satisfied with their treatment in 84.3% of the early weightbearing group and 76.2% of the delayed weightbearing group (p=0.19). The OMAS score was also significantly greater in the early weightbearing group at 6 and 8 weeks post op but this difference leveled off after 12 weeks. The time to return to preinjury activities was also significantly reduced in the early weightbearing group (9.1 +/- 3.0 wks vs 11.0 +/- 3.0 wks). 

Ultimately, this interesting article supports existing literature that shows ankle fractures that are able to be satisfactorily reduced and fixated are likely able to withstand early weightbearing with possibly improved outcomes.