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Scottish Committee for Orthopaedics and Trauma (SCOT)


Early weight-bearing of patients with ankle fractures is associated with good outcomes. There are a number of potential advantages to early mobilisation including reduced hospital stay and earlier return to work and regular daily activities. However, many surgeons have not incorporated this into their routine ankle fracture protocol, particularly for patients managed operatively; potentially due to concerns regarding loss of reduction. We hypothesised that ankle fractures managed fully weight-bearing would have good outcomes and a low rate of loss of reduction.

All ankle fractures presenting to our department over a 15-month period were studied prospectively. Patients were instructed to mobilise fully weight-bearing as able, either immediately postoperatively (for those fractures considered unstable that underwent operative intervention), or at the first fracture clinic review (if stable and managed conservatively). Only patients with syndesmotic injuries and those with neuropathy or psychiatric illness were excluded. The effectiveness of this management protocol was assessed by clinical and radiographic review following fracture union.

847 patients were included, of whom 25% were over the age of 65. 33% of fractures were unstable and therefore managed operatively, 66% were stable and therefore managed in casts or with functional bracing. In every case the radiographs showed maintenance of anatomical mortise and fracture reduction at the time of union, good patient reported outcomes were also recorded.

Early weight-bearing of patients with ankle fractures, whether managed conservatively or operatively, results in very low rates of loss of reduction and should be considered routine management for the majority of patients.