Early versus delayed weight-bearing following operatively treated ankle fracture (WAX): a non-inferiority, multicentre, randomised controlled trial

Review written by Dr Chris Bleakley info

Key Points

  1. Patient-reported outcomes (ankle function and quality of life) were superior in the early weight-bearing group compared to the delayed weight-bearing group.
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BACKGROUND & OBJECTIVE

Each day in the UK, around 200 people fracture their ankle (1) with many requiring surgery. Post-surgical management typically involves immobilization in a cast or boot, along with a period of non-weight-bearing. In 2012, a Cochrane review concluded that the optimal duration of non-weight-bearing for these patients is unclear (2). In recent years, a series of randomized controlled trials have favored early weight-bearing, but this has not been replicated in large, well-designed experiments.

The WAX trial is the largest randomized controlled trial undertaken in this field to date; its primary aim was to determine if an early weight-bearing strategy is comparable to a delayed weight-bearing strategy after operatively treated ankle fracture. Its secondary aim was to perform an economic analysis comparing the direct and indirect cost associated with each intervention arm.

Each day in the UK, around 200 people fracture their ankle, with many requiring surgery.
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Early weight-bearing is at least equivalent to delayed weight-bearing, carries no additional risk of complication, and has a reduced cost.

METHODS

This was a pragmatic randomized controlled trial undertaken across 23 different UK hospitals. Eligible patients had to have been treated with an operation for an ankle fracture in the previous 14 days; this included patients with open fractures, syndesmotic injuries,

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