Early weight-bearing after ankle fracture surgery: a systematic review and meta-analysis of functional outcomes and safety
Abstract Background Early weight-bearing (EWB) following ankle fracture surgery represents a paradigm shift from traditional rehabilitation protocols. This systematic review and meta-analysis evaluated the efficacy and safety of early versus delayed weight-bearing following operative treatment of an...
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BMC
2025-08-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-025-06216-x |
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| author | Chengjing Wang Changqing Li |
| author_facet | Chengjing Wang Changqing Li |
| author_sort | Chengjing Wang |
| collection | DOAJ |
| description | Abstract Background Early weight-bearing (EWB) following ankle fracture surgery represents a paradigm shift from traditional rehabilitation protocols. This systematic review and meta-analysis evaluated the efficacy and safety of early versus delayed weight-bearing following operative treatment of ankle fractures. Methods We systematically searched six databases (PubMed, EMBASE, Cochrane CENTRAL, Web of Science, CINAHL, PEDro) from January 2015 to February 2025. Twelve studies (1,847 participants) comparing early (≤ 2 weeks) versus delayed weight-bearing protocols were included. Primary outcomes included functional scores, pain, range of motion, and complications. Random-effects meta-analyses used standardized mean differences for continuous outcomes and risk ratios for dichotomous outcomes. Results Early weight-bearing demonstrated significant advantages in pain reduction (SMD: +0.32, 95% CI: 0.21–0.43) and ankle dorsiflexion (SMD: +0.38, 95% CI: 0.26–0.50). Patients with EWB returned to work 12.3 weeks earlier and achieved clinically significant pain reduction 6 weeks sooner than delayed weight-bearing patients. Complication risk favored EWB (RR: 0.89, 95% CI: 0.69–1.14), with fewer immobilization-related complications (DVT: 2.5% vs. 6.3%; CRPS: 1.8% vs. 4.7%). Weber B fractures, younger age (< 45 years), and absence of syndesmotic injury predicted optimal EWB outcomes. Diabetic patients showed enhanced benefits from early mobilization compared to delayed protocols. Conclusions Early weight-bearing following ankle fracture surgery results in superior functional outcomes and equivalent safety compared to delayed protocols. Implementation within two weeks post-surgery appears optimal, with benefits most pronounced in Weber B fractures and younger patients. Syndesmotic injuries and diabetes require individualized assessment for optimal rehabilitation timing. |
| format | Article |
| id | doaj-art-16dfbb9f9a454b74ac47ecadce8ae98d |
| institution | Kabale University |
| issn | 1749-799X |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
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| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj-art-16dfbb9f9a454b74ac47ecadce8ae98d2025-08-24T11:40:45ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2025-08-0120112010.1186/s13018-025-06216-xEarly weight-bearing after ankle fracture surgery: a systematic review and meta-analysis of functional outcomes and safetyChengjing Wang0Changqing Li1Department of Orthopedics, The First Affiliated Hospital of Heilongjiang, University of Chinese MedicineDepartment of Orthopedics, The First Affiliated Hospital of Heilongjiang, University of Chinese MedicineAbstract Background Early weight-bearing (EWB) following ankle fracture surgery represents a paradigm shift from traditional rehabilitation protocols. This systematic review and meta-analysis evaluated the efficacy and safety of early versus delayed weight-bearing following operative treatment of ankle fractures. Methods We systematically searched six databases (PubMed, EMBASE, Cochrane CENTRAL, Web of Science, CINAHL, PEDro) from January 2015 to February 2025. Twelve studies (1,847 participants) comparing early (≤ 2 weeks) versus delayed weight-bearing protocols were included. Primary outcomes included functional scores, pain, range of motion, and complications. Random-effects meta-analyses used standardized mean differences for continuous outcomes and risk ratios for dichotomous outcomes. Results Early weight-bearing demonstrated significant advantages in pain reduction (SMD: +0.32, 95% CI: 0.21–0.43) and ankle dorsiflexion (SMD: +0.38, 95% CI: 0.26–0.50). Patients with EWB returned to work 12.3 weeks earlier and achieved clinically significant pain reduction 6 weeks sooner than delayed weight-bearing patients. Complication risk favored EWB (RR: 0.89, 95% CI: 0.69–1.14), with fewer immobilization-related complications (DVT: 2.5% vs. 6.3%; CRPS: 1.8% vs. 4.7%). Weber B fractures, younger age (< 45 years), and absence of syndesmotic injury predicted optimal EWB outcomes. Diabetic patients showed enhanced benefits from early mobilization compared to delayed protocols. Conclusions Early weight-bearing following ankle fracture surgery results in superior functional outcomes and equivalent safety compared to delayed protocols. Implementation within two weeks post-surgery appears optimal, with benefits most pronounced in Weber B fractures and younger patients. Syndesmotic injuries and diabetes require individualized assessment for optimal rehabilitation timing.https://doi.org/10.1186/s13018-025-06216-xAnkle fractureEarly weight-bearingRehabilitationFunctional recoveryMeta-analysis |
| spellingShingle | Chengjing Wang Changqing Li Early weight-bearing after ankle fracture surgery: a systematic review and meta-analysis of functional outcomes and safety Journal of Orthopaedic Surgery and Research Ankle fracture Early weight-bearing Rehabilitation Functional recovery Meta-analysis |
| title | Early weight-bearing after ankle fracture surgery: a systematic review and meta-analysis of functional outcomes and safety |
| title_full | Early weight-bearing after ankle fracture surgery: a systematic review and meta-analysis of functional outcomes and safety |
| title_fullStr | Early weight-bearing after ankle fracture surgery: a systematic review and meta-analysis of functional outcomes and safety |
| title_full_unstemmed | Early weight-bearing after ankle fracture surgery: a systematic review and meta-analysis of functional outcomes and safety |
| title_short | Early weight-bearing after ankle fracture surgery: a systematic review and meta-analysis of functional outcomes and safety |
| title_sort | early weight bearing after ankle fracture surgery a systematic review and meta analysis of functional outcomes and safety |
| topic | Ankle fracture Early weight-bearing Rehabilitation Functional recovery Meta-analysis |
| url | https://doi.org/10.1186/s13018-025-06216-x |
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