Introduction: Multiple studies have demonstrated the safety of early protected-weight bearing after surgical fixation of ankle fractures. However, some surgeons are hesitant to allow early-weight bearing, due to fear of potential complications. The purpose of this study was to systematically review comparative studies comparing early post-operative weight bearing (EWB) and late weight bearing (LWB) on functional outcome and complications in adult patients undergoing surgical fixation of ankle fractures.

Methods: A systematic review of the literature was performed to identify randomized clinical trials or matched cohort studies comparing outcomes of EWB (within 2 weeks post-operatively) and LWB (4-6 weeks post-operatively). The primary outcome was ankle functional outcome as measured by the Olerud Molander Ankle score (OMA). Secondary outcomes included time off work, and complications such as nonunion, malunion, wound complications, and re-operations.

Results: Twelve studies and 798 patients were included at final analysis. The pooled results demonstrated that compared to LWB, EWB results in a near 10-point improvement in OMA scores at 6 weeks post-operatively (p