Immediate Full Weight-Bearing Versus Partial Weight-Bearing After Plate Fixation of Distal Femur Fractures in Elderly Patients. A Randomized Controlled Trial

Abstract

Introduction After surgery for distal femur fractures in elderly patients, weight-bearing is commonly restricted. Immediate non-restrictive weight-bearing might have beneficial effects. There are no randomized studies on the topic. The purpose of this study was to compare the functional outcome between immediate full weight-bearing (FWB) as tolerated and partial weight-bearing (PWB) during the first 8 weeks following plate fixation of distal femur fractures in elderly patients. Methods Patients aged 65 years or older with distal femur fractures of AO/OTA types 33 A2, A3, B1, B2, C1, and C2 were included. Exclusion criteria were impaired cognitive function, concomitant injuries, or inability to follow the postoperative regimen. Internal fixation was achieved with an anatomical lateral distal femur plate applied as a strictly bridge-plating construct. The primary outcome measure was the function index of the short musculoskeletal functional assessment (SMFA) after 52 weeks from injury. Results Thirty-two patients were randomized to FWB (n = 11) or PWB (n = 21). After 16 and 52 weeks, there were no differences in the mean SMFA function index between FWB and PWB (36 vs 43, P = .42 and 52 vs 40, P = .18, respectively) nor in the mean EuroQol 5-dimension index or range of motion (ROM). Overall, the SMFA function index was higher at 52 weeks compared with before injury (44 vs 30, P = .001) as was the mean bothersome index (37 vs 21, P = .011). There was no clear difference in the occurrence of adverse events between the treatment groups. Conclusions There were no differences in functional outcome, adverse events, or ROM between immediate FWB and PWB following plate fixation for a distal femur fracture in elderly patients. A distal femur fracture has a negative effect on the functional status of elderly patients that persists at least up to 1 year following injury.

Successful treatment of a challenging periprosthetic femoral fracture on a premenopausal patient with a long history of immunosuppression

“…According to Keenan et al, immediate weight bearing had no noticeable effect on reoperation risks in patients with lateral locked plate fixation of periprosthetic distal femoral fractures, although these apply to those older patients and not patients with histories of long term glucocorticoid use (4). No differences in functional outcomes were noted in a randomized control study by Paulsson et al (9). In cases of those with obesity, postoperative complications of THP are noticeably increased, which should be a consideration factor when introducing weight bearing exercises in rehabilitation (7).…”

Surgical management and weight-bearing recommendations for geriatric distal femur fractures

“…However, several small series of patients with distal femur fracture have demonstrated similar reoperation rates for restricted and full weight-bearing patients. 4 , 14 However, geriatric nonhip fractures continue to have higher rates of restricted weight-bearing than geriatric hip fractures. 15 The findings of this study further highlight the hesitancy to allow distal femur fractures to immediately weight-bear after surgical fixation.…”

Temporary Partial Weight-Bearing Restriction in Elderly Patients Treated With a Plate Fixation After a Distal Femur Fracture had a Negative Long-Term Impact on Gait Recovery

“…This study evaluated previously unpublished secondary outcomes from a randomized controlled trial investigating the influence of weight-bearing regimens on patient-reported outcomes following surgically treated elderly patients with DFFs. 29 Between January 2013 and June 2016, 32 patients were allocated to immediate full weight-bearing (FWB) or partial weight-bearing (PWB) regimens for 8 weeks.…”