The effectiveness of immediate weight bearing as tolerated versus delayed weight bearing following intramedullary fixation for geriatric intertrochanteric fractures: a post-hoc analysis

Abstract

Background Early weight bearing is an essential variable for fracture healing after osteosynthesis for Intertrochanteric fractures (ITF), which may impact morbidity and mortality. The optimal period to start weight bearing after surgery is still under debate, despite the recommendation of guidelines. The objective of this study was to evaluate the effectiveness of both a delayed and an immediate weight-bearing regimen following intramedullary fixation for elderly ITF. Methods This study is a post-hoc analysis of the multicenter prospective non-randomized controlled study (NCT03184896) listed on Clinicaltrials.gov. Eligible patients were aged ≥ 65 years with X-ray confirmed ITF, admitted within 21 days after injury and received intramedullary fixation surgery. Patients would be excluded if they were diagnosed with pathologic fractures, unable to comply with the rehabilitation program due to physical or psychological problems or received conservative treatment or other types of surgery. Patients bearing weight as tolerated during hospitalization were identified as the immediate weight bearing (IWB) group and patients bearing weight after discharge were identified as the delayed weight bearing (DWB) group in this study. The primary outcome was EQ5D score of patients at 120 days post-surgery. Secondary outcomes include EQ5D score of patients at 30 days and 365 days post-surgery, complication rate and mortality. Results 410 eligible patients enrolled (190 patients with IWB and 220 patients with DWB). Compared to the DWB group, the IWB group had a higher EQ5D score at 30 days and 120 days after surgery (30d, P < 0.001; 120d, P = 0.002). The DWB group had a higher EQ5D score at 365 days after surgery (P = 0.012) than the IWB group. There were no statistical differences in the incidence of any complication, reoperation rate, or cumulative complication rate between the two groups. The one-year mortality was 5.79% in the IWB group and 4.55% in the DWB group (P = 0.542). Conclusions Immediate weight bearing as tolerated following intramedullary fixation for intertrochanteric fractures in elderly patients improves functional outcomes in the early stage (within 120 days after surgery) without increasing the incidence of complications, reoperation, or mortality compared with delayed weight bearing.