Early weight bearing is not associated with short-term complications in ankle fractures

Ankle fractures are common injuries and post-operative protocols continue to vary. We aim to compare postoperative complications between early weight bearing (EWB), intermediate weight bearing (IWB), and delayed weight bearing (DWB) in adult patients with isolated ankle fractures treated with open reduction internal fixation (ORIF). This retrospective cohort study includes 233 adult patients with isolated (medial malleolar, lateral malleolar, posterior malleolar, bimalleolar equivalent) or complex (trimalleolar, trimalleolar equivalent, bimalleolar, and Maisonneuve) ankle fractures treated with ORIF between 2020 and 2022 at a level I trauma center. Patients were weight bearing postoperatively at < 3 weeks (EWB), 3-6 weeks (IWB), or > 6 weeks (DWB). Main outcome measurements include rates of complications requiring reoperation and minor complications. Thirty-one and eight tenths percent (74/233) were EWB, 25.8 % (60/233) were IWB, and 42.5 % (99/233) were DWB. 73.0 % of patients (170/233) had complex fractures, and 27.0 % (63/233) had isolated malleolar fractures. 16.3 % of patients (38/233) developed complications, with 7.7 % (18/233) requiring reoperation. We found no differences in overall complications (14.86 % vs. 11.67 % vs. 20.20 %; p = 0.3396) or complications requiring reoperation (9.46 % vs. 3.33 % vs. 9.09 %; p = 0.3337) among the weight bearing groups for all fractures. Between the complex fracture group and the isolated malleolar fracture group, there were no differences in overall complications (7.94 % vs. 19.41 %; p = 0.0566) or complications requiring reoperation (9.41 % vs. 3.17 %; p = 0.1664). There is not statistical significance between timing to weight bear and complications in ankle fractures treated with ORIF.