110 patients who had undergone acute surgical fixation of an unstable ankle fracture were randomized to compare the efficacy of early weight bearing and mobilization against non-weight bearing and immobilization 12 months after surgical intervention. Patients were primarily assessed for rate of return to work, along with secondary measures of ankle ROM, SF-36 health outcome scores, Olerud/Molander ankle function score, and rates of complications. The evidence presented in this study demonstrates that early weight bearing and non-weight bearing interventions result in similar rates of return to work at all time points, but early-weight bearing contributes to improved early ankle function, ankle ROM, and improved mental and physical health outcomes.