From the Research
After ankle fracture surgery, patients can be made weight-bearing as tolerated immediately following surgery, as this approach has been shown to be safe and effective in certain subsets of patients with stable osteosynthesis, as demonstrated in the most recent and highest quality study 1. This approach, known as immediate weight-bearing as tolerated (IWBAT), allows patients to return to ambulation and activities of daily living faster and may facilitate rehabilitation. The study published in the Lancet in 2024 1 found that an early weight-bearing strategy was clinically non-inferior and highly likely to be cost-effective compared to the current standard of care (delayed weight-bearing). Some key points to consider when implementing IWBAT include:
- The patient must have a stable osteosynthesis, as judged by the responsible surgeon
- The patient must be compliant and highly motivated
- The patient should be closely monitored for any signs of complications, such as loss of fixation or peri-incisional erythema
- The patient should be instructed on proper weight-bearing techniques and should use assistive devices as needed to avoid putting too much pressure on the operated foot. It's also important to note that the decision to use IWBAT should be made on a case-by-case basis, taking into account the individual patient's specific condition and needs. In terms of specific protocols, the study published in Orthopedics in 2024 2 found that early weight bearing resulted in improved short-term ankle function scores, but did not find any significant differences in ankle function at 1 year postoperatively between early and delayed weight bearing and mobilization. Overall, the evidence suggests that IWBAT can be a safe and effective approach for certain patients with ankle fractures, and can help to improve outcomes and reduce recovery time.