Cost-effectiveness of weight bearing in ankle fractures

WAX is a multi-centre, multi-surgeon, two-arm, randomised non-inferiority trial of early versus delayed bearing following ankle fracture surgery. It is being led by surgeons at the Nuffield Department of Orthopaedic Surgery, University of Oxford. Its primary objective is to determine whether allowing patients to bear weight on the operated leg two weeks post-surgery is equally effective as the standard six-week non-weight-bearing approach in terms of functional outcomes, quality of life, adverse events, and cost-effectiveness. “Ankle fractures are common in the UK, with approximately 170 cases occurring daily. While some can be treated with casts or splints, surgical intervention is necessary for others to restore bone alignment and stability. Following ankle fracture surgery, patients are typically advised to avoid weight-bearing for six weeks to facilitate proper healing. However, this conventional approach can lead to complications like blood clots, muscle weakness, and stiffness, resulting in a lack of consensus among UK surgeons on the best treatment.

WAX addresses a critical research priority in trauma care and is expected to offer evidence-based guidance for post-ankle fracture surgical management in the UK. Recruitment and analysis have been completed, and the paper is being prepared for publication. Patients undergoing ankle fracture surgery were randomly assigned to either early weight-bearing or delayed weight-bearing groups. Patient-reported outcomes, healthcare costs, and adverse event rates were compared over the first year post-surgery.

The trial has completed recruitment and analysis, and a paper has been drafted for publication: