Study finds early weight bearing safe for ankle fracture recovery

A new study from the University of Missouri School of Medicine suggests putting weight on an ankle – also known as weight bearing – within three weeks of recovering from a surgically repaired fracture is safe.

There are no set guidelines to follow on when patients can start putting weight on fractured ankle bones, and past research had conflicting results. MU researchers conducted their own study, evaluating the outcomes of 233 patients and sorted them into groups based on how long they were non-weight bearing. They found nothing suggesting the risk of complications is higher in patients who bear weight early.

The point of this study was to examine if early weight bearing after an ankle fracture was safe. Early weight bearing can help speed up a patient's recovery by preventing muscle deconditioning, improving joint range of motion and allowing an earlier return to independence."

Dr. Kyle Schweser, study author 

Evidence also shows patients prefer early weight bearing and less restrictions, as it increases their independence while reducing the need for walking aids.

While the researchers found no significant differences with the chances of complications, there are several potential explanations for this. In the data, patients with other health conditions were more likely to have delayed weight bearing, which means more than six weeks of rest.

"Because we were looking at past data, we could not correct for selection bias. A disproportionate number of patients with diabetes and neuropathy were in the delayed weight bearing group," Schweser said. "We can at least say that healthy patients can weight bear early, and that physicians can use discretion to be more aggressive in sicker patients."

Patients with diabetes and neuropathy are usually more likely to have complications; however, the research team did not observe this in the data. More information is needed before definitively saying whether early weight bearing is safe in high-risk populations, but this is something that can be explored in future research.

"Clinically, at MU Health Care, we recommend early weight bearing for all patients with ankle fractures, except for those with certain conditions," Schweser said. "Patients are typically very happy to walk earlier and begin the process of returning to normalcy. Most patients stop using crutches and other aids quickly and are more satisfied with their care."

Dr. Kyle Schweser is an orthopaedic trauma surgeon and the Division Chief of Foot and Ankle at MU Health Care. He is also an assistant professor of orthopaedic surgery at the MU School of Medicine.

"Early weight bearing is not associated with short-term complications in ankle fractures" was recently published in the Journal of Foot and Ankle Surgery. In addition to Schweser, MU study authors include medical students Clayton Brinkley, Warren Haralson, and Sam Hawkins; Emily Leary, Director of Orthopaedic Biostatistics; James Stannard, orthopaedic surgeon and Medical Director of the Missouri Orthopaedic Institute; Gregory J. Della Rocca, orthopaedic surgeon and Division Chief of Orthopaedic Trauma; and Brett Crist, orthopaedic surgeon and professor of orthopaedic surgery. Resident Jacob Cebulko contributed.