Is immediate weight bearing safe for periprosthetic distal femur fractures treated by locked plating? A feasibility study in 52 consecutive patients

Abstract

BackgroundPeriprosthetic distal femur fractures associated with total knee replacement are increasing in incidence. We hypothesized that a standardized management protocol would result in few implant failures and a low rate of postoperative complications.MethodsRetrospective observational cohort study at an urban level 1 trauma center and academic level 2 trauma center. Consecutive patients with periprosthetic distal femur fractures and stable total knee arthroplasty were included between January 1, 2011 and December 31, 2014. Patients were managed by a standardized protocol of co-management by a hospitalist service, fracture fixation within 24 h of admission by less-invasive locked bridge plating, and immediate unrestricted postoperative weight bearing. The primary outcome measure was the rate of postoperative complications. Secondary outcome measures included time to surgery, intraoperative blood loss, duration of surgery, length of hospital stay, time to full weight bearing, and time to radiographic fracture healing.ResultsFifty four fractures were treated in 52 patients. There were three implant failures, one deep infection, one nonunion and two patients with symptomatic malunion. One patient had knee pain due to patellar component instability associated with valgus alignment. There were ten thromboembolic complications despite consistent anticoagulation. Two patients died within 12 months of injury. Thirty-eight patients had returned to their pre-injury ambulation status at 1 year follow-up.ConclusionA standardized approach of less-invasive locked plating fixation and immediate unrestricted weight bearing appears safe and feasible in the management of this vulnerable patient cohort.Trial registration numberThis is a retrospective observational study without a Trial registration number.

Comparison of outcomes and analysis of risk factors for non-union in locked plating of closed periprosthetic and non-periprosthetic distal femoral fractures in a retrospective cohort study

“…As the practice of the study location was to make all patients non-weightbearing for a minimum of 6 weeks, analysis was not possible in this regard. Although non-weightbearing is commonly the practice followed in many centres, recent studies [7, 46] have shown successful outcomes including high union rates in patients allowed full weightbearing after locked plating of distal femoral fractures. Although no biomechanical proof currently exists, there may be a beneficial effect on fracture site biology from weightbearing.…”

Immediate weight-bearing is safe following lateral locked plate fixation of periprosthetic distal femoral fractures

“…Most studies limited to PDFFs have employed weight-bearing restrictions of duration 6–12 weeks [ 9 , 10 , 20 ]. One previous study of 52 patients allowing immediate unrestricted weight-bearing after minimally invasive LLP fixation reported a favourable reoperation rate of 5/54 (9%) [ 24 ]. Although this previous study did not include a RWB group for comparison, this reoperation figure compares favourably with both that in the current study and those in studies where weight-bearing restrictions were applied: Lotzien et al [ 9 ] n = 45, reoperation rate 22%; Hoellwarth et al [ 10 ], n = 87, reoperation rate 10%; Ruder et al [ 20 ], n = 35, reoperation rate 6%.…”

“…In studies limited to patients with PDFFs, postoperative weight-bearing status has either been restricted [ 9 , 20 ] or not reported [ 10 ]. The safety of unrestricted weight-bearing after LLP fixation of PDFFs has been reported by Smith et al [ 24 ], although no comparative group was included.…”

Fixation of intraoperative proximal femoral fractures during THA using two versus three cerclage wires - a biomechanical study

“…However, even this frequently performed operation is associated with complications. Femoral fractures like fissures of the proximal femur are a frequent intraoperative complication [ 2 ], especially in the presence of limited bone quality (osteopenia or osteoporosis) in geriatric patients [ 3 , 4 ]. There is a trend away from cemented towards uncemented femoral stem fixation, further increasing the risk of intraoperative proximal femoral fractures (IPFF) [ 5 , 6 ].…”