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To weight bear or not to weight bear, that is the question

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Chris Conyard

on 20 March 2014

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Transcript of To weight bear or not to weight bear, that is the question

To weight bear or not to weight bear, that is the question.
Wolff's Law
Animal osteotomy models
Controlled or moderate axial loading of osteotomy site leads to a greater volume of callous and a faster time to union
Are we compliant?
NWB or TWB require 4x energy expenditure vs FWB
Feedback devices innefective
Calcaneal fractures
Ring external fixators
2 small case series:
Intra-articular #'s
Mean 10/52
Maryland foot score
92% good or excellent results
Plate Fixation
No comparative studies of WB vs other
Kienast et al (2009) - 12/52 10kg WB vs
6/52 10kg, 2/52 20kg, 2/52 40kg then FWB
No difference
Ankle Fractures
No difference in:
Functional scores
Radiographic outcomes
The bottom line

"Minimal difference in functional and radiographic outcomes of surgically managed ankle fractures, regardless whether patients were allowed to bear weight immediately or were restricted to non-weight bearing for 4-6/52"
Tibial Shaft Fractures
IM Nailing
Tibial Plateau Fractures
General Recommendations
> 6-8/52 restricted weight bearing post-operatively
Aim to prevent displacement of the fracture
N = 32
AO type 41 B
12 WB, 20 NWB 6-8/52
No implant failure or radiographic #'s
Femoral Shaft Fractures
2 good quality studies
Winquist types II-IV
Reamed IM nail
>90% FWB by 6/52
All united
Hip Fractures
Koval et al.
Weight Bearing After Hip Fracture: A Prospective Series of 596 Geriatric Hip Fracture Patients
Journal of Orthopaedic Trauma
Issue: Volume 10(8), November 1996, pp 526-530
Take home messages
1. High quality data comparing immediate with delayed weight bearing after lower extremity fractures is limited.
2. However, sufficient evidence for:
Ankle fractures
IM nailed femoral shafts
Elderly NOF fractures
3. Insufficient evidence for:
Intra-articular fractures
N = 56
3 groups
Early WB, late ROM
Early ROM, late WB
Late ROM & WB
No difference
limit iatrogenic joint stiffness
limit muscle and bone atrophy
promote cartilage health
prevent VTE
fracture displacement
soft tissue damage
The Basics
Full transcript