Year: 2026 | Month: January | Volume: 13 | Issue: 1 | Pages: 242-251
DOI: https://doi.org/10.52403/ijrr.20260123
Impact of Early Weight Bearing After ORIF of Ankle Fractures: Systematic Review and Meta-Analysis
Kadek Gede Bakta Giri1, I Gede Mahardika Putra1, Made Ramanda Bramasta Pramana2
1Orthopaedic and Traumatology Department, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
2Resident of Orthopaedic and Traumatology Department, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
Corresponding Author: Kadek Gede Bakta Giri
ABSTRACT
Background: Ankle fractures are common lower-limb injuries often requiring open reduction and internal fixation (ORIF). Early weight bearing (EWB), defined as initiating partial or full loading within six weeks postoperatively, may accelerate recovery. This systematic review and meta-analysis compared EWB with late weight bearing (LWB) regarding ankle function, return to work/daily activities, and complication rates.
Methods: PubMed, MEDLINE, EMBASE, and CENTRAL were searched for randomized controlled trials (RCTs) published between 2020 and 2024. Outcomes included standardized ankle function scores at 6, 12, 24–26 weeks, and 1 year, plus time to return to work/daily activities and complication rates. Risk of bias was assessed using the Cochrane tool. Meta-analyses applied fixed- or random-effects models depending on heterogeneity.
Results: Four RCTs (n = 398) were included. EWB improved ankle function at 6 weeks (SMD 0.66; 95% CI 0.46–0.87; p < 0.001), 12 weeks (SMD 0.39; 95% CI 0.03–0.76; p = 0.04), and 24–26 weeks (SMD 0.46; 95% CI 0.02–0.89; p = 0.04). No difference was observed at 1 year (SMD 0.20; 95% CI −0.29–0.70; p = 0.42). EWB shortened time to return to work/daily activities (MD −0.81 weeks; 95% CI −1.46 to −0.16; p = 0.01). Complication rates were comparable (RR 1.06; 95% CI 0.39–2.92; p = 0.90).
Conclusion: EWB enhances early and mid-term ankle function and accelerates return to activity without increasing complications. Long-term outcomes are similar between EWB and LWB. Larger, high-quality RCTs are needed.
Keywords: ankle fracture, ORIF, early weight bearing
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