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Review
. 2025 Aug 11;145(1):402.
doi: 10.1007/s00402-025-06016-2.

Early versus delayed weightbearing for postoperative ankle fractures: a systematic review and meta-analysis of randomized controlled trials

Feifei Wu  1 , Peidang Liu  1 , Zhengkuan Ou  2 , Shiran Zhou  3 , Cheng Zhang  4   5
Affiliations
Review

Early versus delayed weightbearing for postoperative ankle fractures: a systematic review and meta-analysis of randomized controlled trials

Feifei Wu et al. Arch Orthop Trauma Surg. .

Abstract

Background: This meta-analysis aimed to compare the clinical effectiveness of an early weightbearing (EWB) strategy (walking two weeks after surgery) with a delayed weightbearing strategy (DWB) (walking six weeks after surgery) for postoperative ankle fractures.

Methods: Four databases were systematically searched for randomized controlled trials (RCTs) comparing EWB with DWB in patients with postoperative ankle fracture. Outcomes included the Olerud-Molander Ankle Score (OMAS), time to return to work/life, and complications. After screening the literature according to eligibility criteria, data extraction, quality evaluation, and meta-analysis were performed using RevMan 5.3 software. The review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

Results: Ten RCTs with 1276 patients were included in this study. Compared with the DWB group, the EWB group showed greater improvement in OMAS in the early postoperative stage (six weeks) [MD = 5.86, 95% CI = (3.64, 8.08), P < 0.001] and middle stage (12 weeks to four months) [MD = 3.17, 95% CI = (0.84, 5.50), P = 0.008]. However, no significant difference was observed in the late stage (12 months) [MD = 1.86, 95% CI = (-0.50, 4.22), P = 0.12]. In addition, the EWB strategy shortened the average time to return to work/daily life [MD=-1.75, 95% CI = (-2.52, -0.98), P < 0.001]. There was no significant difference in complications between the EWB and the DWB groups [RR = 1.34, 95% CI = (0.96, 1.86), P = 0.08].

Conclusion: The results revealed that the EWB strategy was safe and effective in improving OMAS in the early and middle postoperative stages. Additionally, EWB enabled patients to return to work and daily life earlier than DWB did.

Level of clinical evidence: 1.

Keywords: Ankle fractures; Early weightbearing; Function outcomes; Meta-analysis; Randomized controlled trial.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests.

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