Impact of Early Weight Bearing on Outcomes after Open Reduction and Internal Fixation of Trimalleolar Ankle Fractures

Abstract

Category: Ankle; Trauma Introduction/Purpose: There is a current trend to allow earlier weight-bearing of unstable ankle fractures after fixation. This study offers a unique comparison of early (EWB) versus late weight-bearing (LWB) in operatively stabilized trimalleolar ankle fractures. The purpose of this study was to evaluate union rates, clinical outcomes and complications in patients managed with EWB versus LWB. Methods: We performed a retrospective review of 185 patients with trimalleolar ankle fractures who underwent surgical stabilization. Fixation of the posterior malleolus and weight-bearing status were determined by surgeon preference. EWB was defined as ≥3 weeks and LWB was defined as >3 weeks. Patients were evaluated for fracture union and implant failure. Complications and clinical outcomes included ambulatory status, infection rate and return to surgery. Results: There were 47 (25.4%) patients in the EWB group and 138 (74.6%) in the LWB group. There were 7 nonunions, 1 (14.3%) in the EWB and 6 (85.7%) in the LWB group. Seventy-two (38.9%) posterior malleolar fractures were operatively stabilized which did not affect union rates. Syndesmotic fixation was required in 12.5% of patients despite posterior malleolar stabilization. Syndesmotic fixation increased union rate 2.5 times. Deep infection and open fracture decreased union. There was no difference in implant failure, union rate, infection or return to surgery between groups. Conclusion: No deleterious effect of EWB of operatively treated trimalleolar ankle fractures were found with regards to union, implant failure, infection or reoperation. Syndesmotic fixation may offer an advantage to posterior malleolar fixation with improved union rates.