Effects of Early Weight Bearing on Rehabilitation Outcomes in Patients With Traumatic Ankle and Tibial Plateau Fractures

Inclusion Criteria:

1. Adults ages 18 or older

2. Surgically treated open or closed fractures of the ankle (OTA Codes 44A,B,C) meetingone of the following criteria:

3. bimalleolar fracture requiring fixation of any two malleoli (i.e.lateral/medial, medial/posterior, lateral/posterior)

4. bimalleolar equivalent SER4 fractures (lateral malleolus fracture requiringfixation and no medial or posterior malleolus fixation)

5. trimalleolar fracture with fixation of at least two malleoli (i.e.lateral/medial, medial/posterior, lateral/posterior)

6. Operative treatment of an isolated lower extremity unicondylar tibial plateaufracture (AO/OTA 41B1, Schatzker Type 1or 4) without joint impaction.

Exclusion Criteria:

1. Gustilo Type III injuries or soft tissue injury of either lower extremity that wouldcontra-indicate immediate or delayed WB

2. Syndesmotic injuries/fixation

3. Osteoporosis as defined by treatment with a bisphosphonate and/or other osteoporosismedications, including Prolia and Forteo; or a prior fragility fracture (e.g., spinecompression, proximal humerus, distal radius, femoral neck/intertrochantericfracture)

4. Neuropathy, defined as diagnosis of peripheral neuropathy in medical record,neuropathic foot ulcer, or diminished or absent plantar sensation to light touch.

5. Pathologic fracture related to neoplasm

6. Fractures and dislocations to the ipsilateral or contralateral lower limb thatprevent weight bearing as tolerated after fist post-op visit

7. Other contra-indication to immediate or delayed weight bearing (e.g., ipsilateralfracture effecting weight bearing status such as a calcaneus fracture); fractures ofthe ipsilateral lower extremity that would not affect WB status may be included (e.g., proximal femur, femoral shaft or tibia shaft fractures)

8. Any upper limb injury that would limit upper extremity weight bearing (e.g.,surgical neck fracture of proximal humerus)

9. Injuries to other body systems that would affect the ability to comply with eitherWB protocol (e.g., spinal cord injury; severe TBI; major abdominal or chest injury)

10. Patient has third degree burns on >10% total surface area affecting the study limb

11. Tibial plateau fractures that are required to wear a locking brace or fractures thatrequire fixed immobilization beyond four weeks (e.g., cast)

12. Non-ambulatory pre-injury

13. Pre-injury limitation to ROM of ipsilateral hip, knee or ankle

14. Morbidly obese (BMI ≥40)

15. Documented psychiatric disorder requiring admission in perioperative period

16. Severe problems with maintaining follow-up (e.g., patients who are prisoners orhomeless at the time of injury or who are intellectually challenged without adequatefamily support)