Notas del episodio
## Episode 3: Early vs Delayed Weight-Bearing After Ankle Fracture Surgery (Dehghan + WAX)
In this episode of Ortho Appraised, Dr Rajabifard appraises two randomised trials on weight-bearing after ankle fracture fixation — Dehghan et al. in the Journal of Orthopaedic Trauma and the large multicentre WAX trial in The Lancet. The clinical question: after fixation of an unstable ankle fracture, is it safe to bear weight early rather than staying non-weightbearing for six weeks? Both support letting selected patients walk sooner.
📄 Citation: Dehghan N, McKee MD, Jenkinson RJ, et al. Early weightbearing and range of motion versus non-weightbearing and immobilization after ORIF of unstable ankle fractures: a randomized controlled trial. J Orthop Trauma. 2016;30(7):345–352. DOI: https://doi.org/10.1097/BOT.0000000000000572 — and Bretherton CP, Achten J, Jogarah V, et al. Early versus delayed weight-bearing following operatively treated ankle fracture (WAX): a non-inferiority, multicentre, randomised controlled trial. Lancet. 2024;403:2787–97. DOI: https://doi.org/10.1016/S0140-6736(24)00710-4
Key Takeaways:
* Two RCTs paired: Dehghan (2016, ~100 patients) and the large multicentre WAX trial (2024).
* Dehghan's return-to-work primary was null (51.2 vs 47.8 days, p=0.72), while functional recovery was faster with early motion.
* WAX found early weight-bearing clinically non-inferior and highly likely to be cost-effective.
* Practice implication: early protected weight-bearing is safe in appropriately stable fixed ankle fractures.
* Both excluded the least stable patterns, so they offer least reassurance for those; a baseline return-to-work imbalance affected Dehghan's primary outcome.
🔗 Full papers: https://doi.org/10.1097/BOT.0000000000000572 · https://doi.org/10.1016/S0140-6736(24)00710-4
Keywords: ankle fracture rehabilitation, early weight-bearing, ORIF, WAX trial, orthopaedic trauma evidence.
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