Early Weightbearing Following Open Reduction and Internal Fixation of Unstable Ankle Fractures in a Geriatric Population: A Retrospective Cohort Study.

Background: Ankle fracture incidence is increasing in the elderly. There is a growing trend toward early weightbearing. We investigated the effects of early weightbearing after ankle open reduction and internal fixation (ORIF) in the geriatric population. Methods: A retrospective cohort study was performed of patients aged ≥65 years who underwent ankle ORIF at 3 neighboring community hospitals from 2015 to 2024. A total of 97 were included, with 52 undergoing syndesmotic fixation. Postoperatively, patients were 50% partial weightbearing for 2-3 weeks. Afterward, patients were permitted to bear as much weight as tolerable. Recorded outcomes included fracture union, radiographic maintenance of alignment, hardware failures, wound complications, hardware removals, and the need for repeat surgery. Results: Weightbearing as tolerated was initiated at an average of 16.6 days. All patients achieved fracture union without hardware failure, catastrophic loss of reduction (>2 mm displacement), accelerated posttraumatic arthritis, or need for revision surgery. Fourteen patients (14.4%) experienced minor complications not requiring return to surgery: 3 had delayed wound healing managed with protected weightbearing, 4 had surgical site infections treated with oral antibiotics, and 7 underwent elective hardware removal for symptomatic hardware at an average of 8.6 months postoperatively. Conclusion: This is the largest study to date reporting on the effects of early weightbearing in the geriatric ankle ORIF population. We report no major complications and a limited number of soft tissue-related complications. In a patient population with a known morbidity from prolonged immobility, and with advances in recent fracture fixation, we hope our data help build confidence in early postoperative weightbearing. Level of Evidence: Level IV, retrospective cohort study.