Postoperative Weight-Bearing Protocols Following Open Reduction and Internal Fixation of Ankle Fractures: Current...

» Early postoperative weight bearing initiated within approximately 2 weeks after open reduction and internal fixation of ankle fractures appears safe in selected patients with anatomically reduced fractures and rigid internal fixation and has not been shown to increase complication or hardware failure rates compared with delayed weight bearing in available studies. » These findings, however, should be interpreted cautiously, as most studies do not define fixation adequacy, fracture-specific mechanical characteristics, or actual postoperative loading with sufficient rigor, limiting broad generalizability across fracture patterns and implant constructs. » The most consistent benefit of earlier weight bearing is accelerated short-term recovery, including improved early function, reduced pain, and earlier return to work, while medium- and long-term functional outcomes are generally similar by 6 to 12 months. » Postoperative rehabilitation should be individualized based on fracture morphology, quality of reduction, fixation construct, soft-tissue condition, bone quality, and patient-specific factors such as age, comorbidities, and anticipated compliance, rather than on uniform time-based protocols. » Greater caution is warranted for complex fracture patterns, including trimalleolar fractures, posterior malleolar involvement, syndesmotic fixation, osteoporotic bone, and medically high-risk patients, for whom fracture-specific evidence remains limited. » Future studies should prioritize standardized fracture definitions, objective quantification of postoperative loading, and risk-stratified rehabilitation pathways to better identify which patients derive the greatest benefit from earlier weight-bearing strategies.