• Niloofar Dehghan, Michael D McKee, Richard J Jenkinson, Emil H Schemitsch, Venessa Stas, Aaron Nauth, Jeremy A Hall, David J Stephen, and Hans J Kreder.
• *Department of Orthopaedics, Li Ka Shing Institute, St. Michael's Hospital and the University of Toronto, Toronto, Canada; †Division of Orthopaedics, Department of Surgery, St. Michael's Hospital and the University of Toronto, Toronto, Canada; ‡Division of Orthopaedics, Department of Surgery, Sunnybrook Health Science Centre and the University of Toronto, Toronto, Canada; §Department of Surgery, Western University, London, Canada; ‖Department of Surgery, St. Vincent Medical Center, Portland, OR; ¶Division of Orthopaedics, Department of Surgery, Sunnybrook Health Science Centre and the University of Toronto, Toronto, Canada; and **Division of Orthopaedics, Department of Surgery, Sunnybrook Health Science Centre and the University of Toronto, Toronto, Canada.
• J Orthop Trauma. 2016 Jul 1; 30 (7): 345-52.

ObjectivesThe aim of this study was to compare early weightbearing and range of motion (ROM) to nonweightbearing and immobilization in a cast after surgical fixation of unstable ankle fractures.DesignMulticentre randomized controlled trial.SettingTwo-level one trauma centers.PatientsOne hundred ten patients who underwent open reduction and internal fixation of an unstable ankle fracture were recruited and randomized.InterventionOne of 2 rehabilitation protocols: (1) Early weightbearing (weightbearing and ROM at 2 weeks, Early WB) or (2) Late weightbearing (nonweightbearing and cast immobilization for 6 weeks, Late WB).Main Outcome MeasurementsThe primary outcome measure was time to return to work (RTW). Secondary outcome measures included: ankle ROM, SF-36 heath outcome scores, Olerud/Molander ankle function score, and rates of complications.ResultsThere was no difference in RTW. At 6 weeks postoperatively, patients in the Early WB group had significantly improved ankle ROM (41 vs. 29, P < 0.0001); Olerud/Molander ankle function scores (45 vs. 32, P = 0.0007), and SF-36 scores on both the physical (51 vs. 42, P = 0.008) and mental (66 vs. 54, P = 0.0008) components. There were no differences with regard to wound complications or infections and no cases of fixation failure or loss of reduction. Patients in the Late WB group had higher rates of planned/performed hardware removal due to plate irritation (19% vs. 2%, P = 0.005).ConclusionsGiven the convenience for the patient, early improved functional outcome, and the lack of an increased complication rate, we recommend early postoperative weightbearing and ROM in patients with surgically treated ankle fractures.Level Of EvidenceTherapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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