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Weight-bearing after ankle fracture surgery may not lead to worse outcomes

A new paper by Chris Bretherton from Barts Bone & Joint Health, and published today in The Lancet, shows that weight-bearing after ankle fracture surgery may not lead to worse outcomes for patients, and could help people return to normal activities sooner.

Chris Bretherton

Mr Chris Bretherton

The study was funded by the National Institute for Health and Care Research (NIHR) and was a collaborative effort involving 23 NHS hospitals across the UK. It was conducted to explore the optimal rehabilitation strategy after surgery for a broken ankle, specifically comparing early weight-bearing (starting walking on the repaired ankle two weeks post-surgery) with the traditional delayed weight-bearing (six weeks post-surgery).

The trial results provide compelling evidence that early weight-bearing after ankle surgery is a safe, effective, and cost-efficient alternative to the traditional delayed approach. While further research may be needed to examine the risks of returning to weight-bearing, the study suggests that putting weight on the ankle as it heals may also help reduce the stiffness and muscle atrophy often seen after surgical interventions for a fracture.

Supported by leading health research institutions and involving multiple NHS hospitals, this research paves the way for potentially transformative changes in postoperative care, promising better outcomes.

Chris Bretherton said: "It's fantastic how the NIHR has facilitated collaboration among clinical teams across the UK to challenge the long-standing practice of delayed weight-bearing after surgery. This research will empower surgeons to promote early weight-bearing, significantly aiding patients during the most critical phases of their recovery from ankle fractures."

Interview with the author

We spoke to Chris Bretherton to find out more about this important research, and what it means for patients and outcomes.

What is new about the study?

What sets this study apart is its focus on early weight-bearing after ankle surgery. Traditionally, patients are advised to avoid putting weight on the injured ankle for six weeks. This research introduces and evaluates the safety and effectiveness of allowing patients to start walking just two weeks after surgery. The findings suggest that this early weight-bearing strategy is a viable alternative to the conventional approach.

Is there anything surprising about the results?

Yes, the results were quite surprising. Before the study, clinicians thought that early weight-bearing might produce similar results to delayed weight-bearing and just make life a bit easier for patients during their recovery. Instead the study found that patients who began weight-bearing two weeks post-surgery had comparable, if not better, outcomes in ankle function at four months compared to those who had the six-week weight-bearing delay. Additionally, the study showed that early weight-bearing is likely to be cost-effective, potentially leading to lower healthcare costs without increasing the risk of complications.

Why is the study important?

This study is crucial as it challenges the long-standing rehabilitation guidelines for ankle fractures. By demonstrating that early weight-bearing is not only safe but also potentially more beneficial in terms of functional recovery and cost, it opens the door for new treatment protocols. These findings can lead to quicker recovery times, reduced healthcare costs, and improved patient outcomes, making a significant impact on how ankle fractures are managed post-surgery.

What are the wider implications?

The wider implications of this study are substantial. If early weight-bearing becomes the new standard of care, it could revolutionise postoperative rehabilitation for ankle fractures. Patients might experience faster recovery times and better long-term outcomes. Healthcare systems could benefit from reduced costs associated with prolonged rehabilitation and potential complications from delayed mobility. Additionally, these findings could prompt further research into early mobilization strategies for other types of fractures and surgeries, potentially leading to broader changes in orthopedic rehabilitation practices.

More information

Research paper: Bretherton, C.P. et al. (2024) ‘Early versus delayed weight-bearing following operatively treated ankle fracture (wax): A non-inferiority, multicentre, randomised controlled trial’, The Lancet. doi:10.1016/s0140-6736(24)00710-4.



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