Early Versus Late Weight-Bearing After Ankle Fracture Surgery: A Comparative Review

Early weight-bearing (EWB) and late weight-bearing (LWB) protocols are the two primary regimens implemented for patients following ankle fracture surgery, yet their outcomes remain variable. This review aimed to assess these protocols, including their limitations and implications, to support more tailored postoperative management and ultimately improve patient recovery. EWB demonstrated superior short-term outcomes compared to LWB, including higher functional assessment scores, improved range of motion, and earlier return to work times. However, patients in this group revealed lower protocol adherence and higher wound-related issues in select patients, including complication and reoperation rates. As a result, LWB is more often favored by surgeons for elderly, diabetic, or morbidly obese patients despite lower early functional outcome scores. Overall, the literature remains inconclusive, highlighting the need for personalized rehabilitation plans and further research to refine risk stratification and optimize recovery across diverse patient populations.