Outcomes Following Early Weight Bearing in Syndesmotic Injuries: A Randomized Controlled Trial
In brief
Early weight bearing matched delayed loading on fixation and added 6.5 degrees of dorsiflexion
In a randomized trial, 39 patients who completed follow-up after ankle fracture fixation had similar syndesmotic alignment and complication rates whether they began weight bearing at 2 or 6 weeks. Early weight bearing brought more pain at 2 weeks but about 6.5 degrees more dorsiflexion at 1 year; the small, single-center trial leaves results uncertain beyond patients treated with flexible fixation.
- Journal
- Journal of orthopaedic trauma (Q1)
- Published
- 5 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Mubinah Khaleel, Elizabeth Durante, Sam Hawkins, James P Stannard, Gregory J Della Rocca, Brett Crist, et al.
- PMID
- 42831579
- DOI
- 10.1097/BOT.0000000000003296
Why clinicians should know about it
- Picked for Orthopedics and Sports Medicine (paper of the day, 7 October 2026): Early weight bearing after syndesmotic fixation improves dorsiflexion
Abstract
OBJECTIVES: To compare outcomes of early weight bearing (EWB) at 2-weeks versus delayed weight bearing (DWB) at 6-weeks following operative ankle fracture fixation with syndesmotic stabilization. METHODS: Design: Prospective randomized controlled clinical trial. SETTING: Single Level 1 Trauma Center. PATIENT SELECTION CRITERIA: Adult patients with operative rotational ankle fractures (OTA/AO 44A-C) and an intraoperative finding of syndesmotic injury following fracture fixation between September 2019 and September 2022 were included. All underwent dynamic syndesmotic stabilization utilizing a single suture button. Exclusion criteria were fibular fractures not amenable to length-stable fixation (e.g., Maisonneuve injuries), neuropathic diabetes, body weight ≥147.4 kg (325 lbs), imprisonment, pregnancy, lactation, end-stage renal disease, cognitive dysfunction, or polytrauma. OUTCOME MEASURES AND COMPARISONS: Maintenance of syndesmotic reduction at 1 year comparing immediate postoperative and 1-year CT scans of both ankles was the primary outcome. Secondary outcomes: pain (VAS), surgical satisfaction (SSQ-8), functional scores (AAOS Foot and Ankle), ankle range of motion, and complications. RESULTS: 106 patients were enrolled: 40 underwent syndesmotic fixation and were randomized. 16 patients (mean age 41 (21-80), 9 female, 7 male) randomized to EWB and 23 (mean age 43 (23-85), 12 female, 11 male) to DWB completed the study. Fracture types included lateral malleolar (OTA/AO 44A), bimalleolar and bimalleolar equivalent (OTA/AO 44B), and trimalleolar (OTA/AO 44C) fractures, with similar distribution between groups (p=0.96). EWB group had significantly higher pain scores (4.6 ± 2.8 vs 2.8 ± 2.3, p = 0.039) at the 2-week visit compared to DWB. At 1 year, dorsiflexion in the EWB group was significantly higher (14.2° ± 3.9° vs 7.7° ± 4.4°) than the DWB (p = 0.017). No significant difference in syndesmotic malreduction (p>0.99), loss of reduction (p>0.89), PROs, development of arthritis (p>1.0) or complication rates (p>0.37) at any other timepoint. CONCLUSIONS: Early weight bearing at 2-weeks was noninferior to delayed weight bearing at 6-weeks following rotational ankle fracture fixation with a syndesmotic injury stabilized with flexible fixation. LEVEL OF EVIDENCE: Level I.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.