110 patients who had undergone open reduction and internal fixation for an unstable ankle fracture were randomized to either early weight-bearing (i.e. mobilization and weight-bearing at 2 weeks) or delayed weight-bearing (i.e. immobilization and casting until 6 weeks). The purpose of this study was to compare these two postoperative protocols with respect to physical function, quality of life and the incidence of complications. Results indicated that the early protocol yielded significantly improved physical function, ankle range of motion, as well as mental and physical health outcomes scores at 6 weeks. There was no significant between-group difference in the rate of return to work or the incidence of complications.