• Jan Paul Briet, Roderick M Houwert, Diederik P J Smeeing, Janity S Pawiroredjo, Johannes C Kelder, Koen W Lansink, Luke P H Leenen, Peer van der Zwaal, Stephan W A M van Zutphen, Jochem M Hoogendoorn, Mark van Heijl, Egbert J M M Verleisdonk, Guus W van Lammeren, Michiel J Segers, and Falco Hietbrink.
• Department of Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, Postbus 80250, 3508 TG, Utrecht, The Netherlands. jp.briet@gmail.com.
• Trials. 2015 Apr 18; 16: 175.

BackgroundThe optimal post-operative care regimen after surgically fixed Lauge Hansen supination exorotation injuries remains to be established. This study compares whether unprotected weight bearing as tolerated is superior to protected weight bearing and unprotected non-weight bearing in terms of functional outcome and safety.Methods/DesignThe WOW! Study is a prospective multicenter clinical trial. Patients between 18 and 65 years of age with a Lauge Hansen supination exorotation type 2, 3 or 4 ankle fractures requiring surgical treatment are eligible for inclusion. An expert panel validates the classification and inclusion eligibility. After surgery, patients are randomized to either the 1) unprotected non-weight-bearing, 2) protected weight-bearing, or 3) unprotected weight-bearing group. The primary outcome measure is ankle-specific disability measured by the Olerud-Molander ankle score. Secondary outcomes are 1) quality of life (e.g., return to work and resumption of sport), 2) complications, 3) range of motion, 4) calf wasting, and 5) maximum pressure load after 3 months and 1 year.DiscussionThis trial is designed to compare the effectiveness and safety of unprotected weight bearing with two commonly used post-operative treatment regimens after internal fixation of specified, intrinsically stable but displaced ankle fractures. An expert panel has been established to evaluate every potential subject, which ensures that every patient is strictly screened according to the inclusion and exclusion criteria and that there is a clear indication for surgical fixation.Trial RegistrationThe WOW! Study is registered in the Dutch Trial Register ( NTR3727 ). Date of registration: 28-11-2012.

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