For decades, patients who broke their ankle and needed surgery were told the same thing:

“No weight on it. Six weeks. Don’t risk it.”

But what if that long period on crutches isn’t always necessary?

A major Irish multicentre randomised controlled trial is now challenging that traditional approach — and it could change how ankle fractures are managed worldwide.

The Study That Questions Old Habits

The research, led by Ramy Khojaly and colleagues and published in Trials (2021), is called the INWN Study — short for Is Non-Weight-Bearing Necessary?

It investigates a bold question:

After ankle fracture surgery (ORIF), can patients safely begin immediate weight-bearing and ankle movement, instead of remaining non-weight-bearing in a cast for six weeks?

This was not a small pilot study.

It was designed as a pragmatic randomised multicentre trial, involving three major trauma centres in Ireland. Patients were randomly assigned to one of two groups:

Group A:

• Walking boot

• Immediate weight-bearing as tolerated

• Early ankle range-of-motion exercises

Group B:

• Traditional below-knee cast

• Strict non-weight-bearing for 6 weeks

The researchers are tracking functional recovery, complications, ankle motion, return to work, and overall health scores for up to one year.

Why Does This Matter?

Ankle fractures are common — affecting both young adults and the elderly.

Traditional prolonged immobilisation may:

• Reduce mobility

• Delay return to work

• Increase muscle stiffness

• Affect independence

Yet surgeons have long feared that early weight-bearing could cause:

• Wound problems

• Fixation failure

• Hardware displacement

Previous studies gave mixed answers. Some suggested earlier movement improved function. Others warned of complications.

This new trial aims to provide stronger, more modern evidence.

What Are They Measuring?

The primary outcome is the Olerud-Molander Ankle Score (OMAS) at 6 weeks — a validated measure of ankle function.

Secondary outcomes include:

• Wound infection

• Fixation failure

• Range of motion

• Quality of life (RAND-36)

• Return-to-work timing

• Hospital stay length

The study was powered to detect a meaningful 10-point difference in ankle function scores.

The Bigger Picture

Importantly, both approaches are already used in routine practice.

The researchers note that NICE (UK) has called for more evidence in this area, highlighting that postoperative weight-bearing strategy remains uncertain

If early protected weight-bearing proves equally safe — or superior — it could:

• Shorten recovery time

• Improve independence

• Reduce societal costs

• Help patients return to work sooner

However, safety remains central. The study includes strict monitoring for complications and would terminate early if complication rates exceed 20%.

This is careful science — not reckless change.

Study Summary Table

Disclaimer 

This article discusses published clinical research for educational purposes only.

It does not provide medical advice, diagnosis, or treatment recommendations.

Individual recovery plans after ankle fracture surgery vary depending on fracture type, surgical technique, bone quality, wound condition, and personal health factors.

Patients should always follow the specific advice of their treating orthopaedic surgeon or healthcare professional.

ORIEMS FIT does not claim to diagnose, treat, cure, or prevent any medical condition. Any rehabilitation decisions should be made in consultation with qualified medical practitioners.