The optimal timing of weight-bearing after surgical fixation of isolated lateral malleolar fractures remains debated. Although delayed mobilization is commonly practiced, early weight-bearing has been proposed as a strategy to improve functional recovery without increasing complications. This study compared early versus delayed weight-bearing following operative treatment of AO/OTA 44-B1 fractures using a homogeneous fracture cohort. This retrospective cohort study included 89 adults who underwent open reduction and internal fixation for isolated lateral malleolar fractures between January 2018 and December 2021. Patients were managed with either early weight-bearing initiated within two weeks postoperatively (n = 37) or delayed weight-bearing after six weeks (n = 52). All patients had a minimum follow-up of 24 months. Outcomes included postoperative complications, radiographic union time, and final functional status using the American Orthopaedic Foot and Ankle Society (AOFAS) score. Statistical analyses included chi-square tests, t-tests, and exploratory logistic regression. Overall complication rates did not differ significantly between the early and delayed groups (3/37 8.1% vs. 6/52 11.5%, p = 0.61). Time to radiographic union was comparable (7.1 ± 1.2 vs. 7.3 ± 1.5 weeks, p = 0.43). Final AOFAS scores were similar between groups (91.8 ± 5.4 vs. 90.9 ± 6.2, p = 0.47). AOFAS ≥ 90 was achieved in 32/37 (86.5%) patients in the early group and 41/52 (78.8%) in the delayed group (p = 0.38). In exploratory multivariate analysis, early weight-bearing was not significantly associated with postoperative complications. Early weight-bearing after operative fixation of isolated lateral malleolar fractures was not associated with increased complication rates or delayed union in this retrospective cohort. Functional outcomes were comparable between groups. These findings suggest that early weight-bearing may be considered in appropriately selected patients with stable fixation; however, prospective randomized studies are required to confirm these results.
Güzel et al. (Mon,) studied this question.