Early versus delayed weight bearing after ankle fracture fixation

Ankle fractures are a common lower extremity injury that requires operative management and the appropriate postoperative rehabilitation protocol is constantly evolving to improve patient outcomes. It is suggested that mobilization/ mobilization within a few days of surgery (ORIF) enhances functional recovery, minimalizes pain and reduces time to full - weight bearing without implications for complication rates but as yet the balance of clinical opinion shows varying levels of evidence. Objectives This randomized prospective comparative study conducted at Tikrit Teaching Hospital from March 2024 to December 2025 was designed to compare the clinical, functional and radiographic results in a cohort of two hundred adult patients aged 18-65 with unstable ankle fractures either treated with an early weight bearing (beginning after two weeks of surgery) or delayed weight bearing (after six weeks). Subjects were randomized into 2 groups of equal size and underwent standardized operative fixation and structured rehabilitation protocols that differed only in weight-bearing time. Six weeks, twelve weeks, and six months postoperative outcome were evaluated with validated functional scoring (Olerud-Molander Ankle Score; AOFAS Ankle-Hindfoot score), pain evaluation with VAS (Visual Analog Scale), radiographic consolidation progression, and complications. The early weight bearing group had higher functional scores and less pain at early follow-up, advanced more rapidly to full weight bearing than the delayed group, but no long-term difference in function and complication rates existed at six months. These findings support the incorporation of early weight-bearing protocols following stable ORIF fixation of ankle fractures with no added risk and short-term gains. Studies in the future should work to further tailor personalized rehabilitation timelines toward long-term functional outcomes on an individual basis and in varying subpopulations of patients.