The impact of early weight-bearing on results following anterior cruciate ligament reconstruction.

INTRODUCTION: Anterior cruciate ligament (ACL) ruptures are common injuries that typically affect young, physically active individuals and may require surgical reconstruction. Studies have shown that the long time success of ACL reconstruction depends on the surgical technique and the postoperative rehabilitation strategy. However, there is still no consensus on the content of rehabilitation programs. Hence, additional research is required to elucidate the significance of early weight-bearing in the rehabilitation process following ACL reconstruction. The aim of this article is to examine the impact of weight-bearing on the clinical results of ACL reconstruction. MATERIALS AND METHODS: We retrospectively reviewed patient records who had undergone arthroscopic reconstruction using a semitendinosus-gracilis tendon graft for anterior cruciate ligament rupture between January 2018 and December 2020. The study included the data of 110 patients. The patients were split into two groups: Group 1 underwent early weight-bearing, while Group 2 followed a non-weight-bearing regimen for three weeks. We assessed the patients using the anterior drawer test, Lachman test, range of motion, Lysholm knee scale, Cincinnati scale, Tegner scale, International Knee Documentation Committee (IKDC) form and clinical records. Analytical tests were conducted to compare the results. RESULTS: The complication rates did not show a significant difference between the groups. Group 1 had higher frequencies of positive anterior drawer and Lachman tests. The Lysholm and Cincinnati knee scores of patients in Group 1 were notably lower than those of patients in Group 2. Additionally, the Tegner activity scores and IKDC scores of patients in Group 1 were also meaningfully lower than those of patients in Group 2. In Group 1 patients, there was no notable relationship observed between body mass index (BMI) and the results of the anterior drawer test (ADT) or Lachman test. However, patients with a BMI of 25 or higher in Group 1 showed a decrease in postoperative IKDC scores. In Group 2 patients, no significant relationship was identified between BMI and either the ADT or the Lachman test outcome. CONCLUSION: Based on current literature and current rehabilitation guidelines following ACL reconstruction, the decision to initiate early weight-bearing is based on a limited number of studies with low levels of evidence. In our study, we found that patients who followed a non-weight-bearing regimen for 3 weeks after surgery had better mid-term results than those who were allowed to bear weight early. It appears that further prospective studies on this topic are needed to update rehabilitation guidelines in the next.

Effect of early weight bearing program with conventional physiotherapy on functional outcomes in surgically treated proximal tibia fracture: a pilot randomized controlled trial.

INTRODUCTION: Patients are often instructed to avoid weight bearing on the proximal tibia for 6 - 12 weeks post-surgery to avoid fracture fixation failure. However, delayed weight bearing leads to delayed mobility, causing difficulties in daily activities; problems such as pain, limited knee ROM, reduced quadriceps muscle strength, and impaired functional outcomes are reported in long-term follow-up. This study primarily aimed to evaluate the feasibility and explore the effect size. The secondary aim was to determine the effectiveness of early weight bearing along with conventional physiotherapy on functional outcomes. MATERIALS AND METHODS: A single-blinded pilot randomized controlled trial with 30 participants with proximal tibia type I, II, and III fractures were included; they were randomized using computer-based software. Seven patients were lost to follow-up. Group I received early weight bearing along with conventional physiotherapy whereas Group II received restricted weight bearing along with conventional physiotherapy. Assessments were made on post-operative day 3 (POD-03), at discharge, at 6 weeks, and at 12 weeks. Radiographs were recorded immediately after the operation, at discharge, and at 12 weeks. RESULTS: A full-scale RCT is feasible with an effect size between 0.3 - 0.7. A statistically significant difference (p < 0.05) was found within both groups 12 weeks post-surgery in all outcome measures; the difference was more prominent in the intervention group. A statistically significant difference (p < 0.05) was found between both the groups post-12 weeks in all outcome measures except quadriceps isometric muscle strength. CONCLUSION: A full-scale RCT for early weight bearing along with conventional physiotherapy for patients operated for Type I, II, and III proximal tibia fracture is feasible. Early weight bearing along with conventional physiotherapy could have a positive effect on reducing patient's pain perception and increasing knee joint mobility, quadriceps isometric muscle strength, knee function, and quality of life without any adverse effects. TRIAL REGISTRATION: ClinicalTrialsRegistry.gov (CTRI/2022/10/046797).

Is immediate weight bearing safe for subtrochanteric femur fractures in elderly patients treated by cephalomedullary nailing? A multicentric study in one hundred eighty-two patients.

PURPOSE: Biomechanical superiority of intramedullary nails over extramedullary implants has been proved for subtrochanteric fractures. Nevertheless, postoperative management of these patients has not changed, with high rates of protected weight-bearing after intramedullary nailing. The purpose of this study is to determine the mechanical complications of immediate postoperative full weigh-bearing for subtrochanteric femur fractures in elderly patients treated with a cephalomedullary nail. METHODS: We performed a retrospective case series study from patients treated with a cephalomedullary nail for subtrochanteric fractures (AO/OTA 31A.3 and 32A-32C) over a nine-year period. Patients in the immediate full weight-bearing (IFWB) group received orders for immediate full weight bear as tolerated on postoperative 48 h. Patients in the non- or limited- weight-bearing (NLWB) group received orders not to full weight bear in the immediate postoperative. RESULTS: There were five (2.7%) cases of implant failure including four cutouts and one nail breakage that needed a reoperation. Of them, one (2.2%) followed the NLWB protocol and four (2.9%) followed the IFWB protocol. Mean length of stay was 7.9 days (median 8, range 3-21) in the NLWB group and 10.7 days (median 8, range 2-60) in the IWBAT group. The NLWB group observed a 2.8-day shorter postoperative length of stay when compared to the IFWB, but the median remained equal. CONCLUSION: This study suggests that geriatric patients with subtrochanteric fractures treated by intramedullary nailing and in which a good fracture reduction was achieved, may be able to tolerate immediate postoperative full weight-bearing, not increasing reoperation rates due to implant failure.

Weight-bearing Guidelines for Common Geriatric Upper and Lower Extremity Fractures.

PURPOSE OF REVIEW: The purpose of this review paper is to summarize current weight-bearing guidelines for common geriatric fractures, around weight-bearing joints, of the upper and lower extremities. RECENT FINDINGS: There is an increasing amount of literature investigating the safety and efficacy of early weight-bearing in geriatric fractures, particularly of the lower extremity. Many recent studies, although limited, suggest that early weight-bearing may be safe for geriatric distal femur and ankle fractures. Given the limited data pertaining to early weight-bearing in geriatric fractures, it is difficult to establish concrete weight-bearing guidelines in this population. However, in the literature available, early weight-bearing appears to be safe and effective across most injuries. The degree and time to weight-bearing vary significantly based on fracture type and treatment method. Future studies investigating postoperative weight-bearing protocols should focus on the growing geriatric population and identify methods to address specific barriers to early weight-bearing in these patients such as cognitive impairment, dependence on caregivers, and variations in post-acute disposition.

Is unrestricted weight bearing immediately after fixation of rotationally unstable pelvic fractures safe?

INTRODUCTION: Rotationally unstable pelvic fractures treated with surgical fixation have traditionally been treated with restricted weight bearing on the affected side for 6-8 weeks post operatively. We have been developing pelvic fixation standards to allow for unrestricted weight bearing immediately post operatively in type B rotationally unstable pelvic fractures. AIMS: To assess for safety and efficacy of allowing unrestrictive weight bearing in this cohort of patients, we have clinically and radiologically monitored outcomes up to two years post operatively. METHODS: Through retrospective review, two cohorts of patients with Tile Type B pelvic fractures were identified that were treated at the Royal Adelaide Hospital, South Australia. Patient demographics, injury classification, surgical fixation and weight bearing status post operatively was recorded. One cohort of patients was allowed to fully weight bear post operatively, whilst the other was treated with 6 weeks of restricted post op weight bearing. At clinical follow up, post-operative x-rays were assessed for loss of reduction, screw or plate breakage and reoperation. RESULTS: Between January 2018 and January 2021, 53 patients with rotationally unstable pelvic fractures that underwent surgical fixation were included in this study. One group of patents were allowed to immediately weight bear as tolerated (WBAT) post operatively (n = 28) and the other with restricted weightbearing (RWB) (n = 25). There was 1 re operation for failure of fixation in each group. Metalwork breakage was more common in the WBAT group than in the RWB group and this was seen only in APC fractures. This increase in metalwork failure was not associated with loss of reduction. CONCLUSIONS: With surgical fixation, Tile type B rotationally unstable pelvic fractures can be allowed immediate weight bearing post operatively. We found this to be safe and effective, employing surgical strategies to address both anterior and posterior injuries to allow immediate unrestricted weight bearing. Broken metalwork was more commonly seen in the WBAT group but this was not associated with loss of reduction or reoperation.

1.7 cm elongated Achilles tendon did not alter walking gait kinematics 4.5 years after non-surgical treatment.

PURPOSE: The aim of the present study was to evaluate Achilles tendon length after non-surgical treatment of acute Achilles tendon rupture (aATR), and to evaluate indirect effects of possible persistent elongation on kinematics. METHODS: The study was performed as a cross-sectional study based on a population of patients from an RCT regarding non-operative treatment of aATR. Thirty-seven patients out of the 56 in the original RCT participated with at a follow up of 4-5 years after aATR. Primary outcome was Achilles tendon elongation. Additional outcomes were Achilles tendon resting angle (ATRA), calf circumference, passive ankle plantar and dorsiflexion and loading pattern. Foot pressure mapping was performed to measure plantar loading distribution pattern; medial and lateral forefoot peak pressure, heel peak pressure, medial versus lateral loading pattern and timing of heel lift during roll over process. The healthy leg was used as a control. RESULTS: The injured Achilles tendon was significantly elongated by 1.7 (SD 1.6) cm compared to the non-injured leg. A slight delay of 2.6% (SD 6.0) was measured in heel lift in the injured side compared to the non-injured leg. We found no significant difference in forefoot peak pressure, medial and lateral peak pressure as well as heel peak pressure, and no correlation was found between Achilles tendon length and pressure measurements. Finally, dorsiflexion was 1.9°(SD1.28) larger, ATRA 8.1°(SD6.7) larger, and calf circumference 1.6 cm (SD1.1) lower on the injured leg. CONCLUSION: The Achilles tendon was 1.7 cm elongated 4.5 years after the initial injury and significant changes in ATRA, calf circumference and passive dorsiflexion was present. Except for a slight delay in heel lift-off, kinematics during walking was symmetrical between injured and healthy leg, even with an elongated tendon on the injured leg. The clinical relevance of the Achilles tendon elongation is uncertain. LEVEL OF EVIDENCE: II. CLINICAL TRIALS IDENTIFIER: NCT02760784.

Early versus late weight bearing & ankle mobilization in the postoperative management of ankle fractures: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: While open reduction and internal fixation is currently considered the optimum treatment option for displaced ankle fractures, the most optimal post-operative rehabilitation strategy in this setting remains unclear. The objective of this investigation was to compare the effect of early vs. late weight bearing and ankle mobilization in the post-operative management of ankle fractures. METHODS: Medline, Embase, CENTRAL, Scopus, CINHAL, and Web of Science were searched to identify randomized controlled trials (RCTs) and quasi-RCTs. Two review authors screened articles, abstracted data, and evaluated risk of bias in duplicate. Outcomes of interest included post-operative ankle function and overall time to return to work. Studies on weight bearing and ankle mobilization were analysed separately and all data were pooled using random-effects models. RESULTS: Eighteen trials were included in the review of which 14 were included in the meta-analysis of at least one outcome of interest. Majority of the studies presented a high overall risk of bias. Early weight bearing demonstrated significantly better short-term postoperative functional scores at 6-9 weeks postoperatively (SMD: 0.39, 95% CI: 0.19, 0.58; p < 0.0001; I2 = 0%). However, the functional effect of early weight bearing compared to late weight bearing gradually became equivalent by the 6 month postoperative time-period. Early weight bearing also demonstrated a significant reduction in the time to return to work/daily activities (MD: -12.29, 95% CI: -17.39, -7.19; p < 0.0001; I2 = 0%). In comparison, no significant differences were found between early ankle mobilization/exercises and immobilization. CONCLUSION: Our findings suggest a potential role of EWB in improving post-operative ankle-function in the short-term and reducing the overall time to return to work/daily activities, but no clinical benefit associated with early ankle mobilization post-surgery.

Functional outcome of early weight bearing for acute Achilles tendon rupture treated conservatively in a weight-bearing orthosis.

BACKGROUND: The optimal management for Achilles tendon (AT) ruptures is controversial and still continues to encourage debate. Conventionally, operative repair was favoured secondary to its lower rates of re-rupture, however in more recent years, we have seen promising results and a reduction in complications with conservative management. One reason for this improvement may be due to the introduction of a functional weight-bearing orthosis, however, results for complete AT ruptures is still unclear. This study aims to evaluate the functional outcomes of early weight bearing in a functional orthosis for conservatively managed, complete AT ruptures. METHODOLOGY: This study was done at East Kent Hospital University Foundation Trust in between 2019-2020. In this prospective study, we have analysed data from 41 patients with US diagnosed compete AT ruptures, with a gap less than 5 cm. Every patient was treated in a functional weight-bearing orthosis (VACOped®) for 8 weeks with early weight-bearing following a specific treatment protocol, followed by rehabilitation with a trained physiotherapist. All patients received a final follow-up at 1 year post injury, where we recorded the following functional outcome measurements on each leg: calf girth, single leg heel raise height, single leg heel raise repetitions and the ATRS score. RESULT: Our study population was predominantly male with an average age of 50 (range 22-79). The majority of the cohort were physically active, with more than 75% involved in a form of sporting activity pre-injury and 15% involved in higher level activity and competitive sport. The mean ATRS score was 82.1, with a re-rupture rate of only 2%. The average calf bulk difference was 1.6 cm, average heel raise height difference was 1.8 cm and a heel raise repetition difference of 6. There was a statistically significant correlation between ATRS score and calf muscle girth (p = 0.02). However, there was no significant correlation between ATRS score and heel raise height or single heel raise repetitions. CONCLUSION: Early weight-bearing in a functional orthosis provides excellent functional outcomes for conservatively managed, complete AT ruptures, and is associated with very low re-rupture rates. However, a multidisciplinary approach with a guided rehabilitation programme is essential for optimising functional outcome.

Immediate weight bearing as tolerated (WBAT) correlates with a decreased length of stay post intramedullary fixation for subtrochanteric fractures: a multicenter retrospective cohort study.

BACKGROUND: Subtrochanteric femur fractures associate with a relatively high complication rate and are traditionally treated operatively with a period of limited weight bearing. Transitioning from extramedullary to intramedullary implants, there are increasing biomechanical and clinical data to support early weight bearing. This multicenter retrospective study examines the effect of postoperative weight bearing as tolerated (WBAT) for subtrochanteric femur fractures. We hypothesize that WBAT will result in a decreased length of stay (LOS) without increasing the incidence of re-operation. METHODS: This study assesses total LOS and postoperative LOS after intramedullary fixation for subtrochanteric fractures between postoperative weight bearing protocols across 6 level I trauma centers (n = 441). Analysis techniques consisted of multivariable linear regression and nonparametric comparative tests. Additional subanalyses were performed, targeting mechanism of injury (MOI), Winquist-Hansen fracture comminution, 20-year age strata, and injury severity score (ISS). RESULTS: Total LOS was shorter in WBAT protocol within the overall sample (7.4 vs 9.7 days; p < 0.01). Rates of re-operation were similar between the two groups (10.6% vs 10.5%; p = 0.99). Stratified analysis identified patients between ages 41-80, WH comminution 2-3, high MOI, and ISS between 6-15 and 21-25 to demonstrate a significant reduction in LOS as a response to WBAT. CONCLUSION: An immediate postoperative weight bearing as tolerated protocol in patients with subtrochanteric fractures reduced length of hospital stay with no significant difference in reoperation and complication rates. If no contraindication exists, immediate weight bearing as tolerated should be considered for patients with subtrochanteric femur fractures treated with statically locked intramedullary nails. LEVEL OF EVIDENCE: Therapeutic Level III.

Early weight-bearing in nonoperative treatment of acute Achilles tendon rupture did not influence mid-term outcome: a blinded, randomised controlled trial.

PURPOSE: Acute Achilles tendon rupture leads to impaired outcome at short term, but little is known concerning medium-term results. The aim of the present study was to investigate the influence of early weight-bearing on clinical outcome 4.5 years after nonoperative treatment of acute Achilles tendon rupture. METHOD: The study was performed as a medium-term follow-up on patients included in a randomised controlled trial. Both groups were treated with nonoperative management and controlled early motion. The intervention group was allowed full weight-bearing from day 1, and the control group was non-weight-bearing for 6 weeks. 60 patients were randomised 1:1. Of those, 56 were eligible for inclusion in the medium-term follow-up and 37 participated (18 control, 19 intervention). The outcomes were Achilles tendon Total Rupture Score (ATRS) and heel raise work performed at an average of 4.5 years after the initial injury. Statistical analysis was performed using paired t tests and linear regression. RESULTS: No differences were found between control and intervention groups at 4.5 years. ATRS scores consistently improved in both the intervention and the control groups from 0.5 to 1 year and from 1 to 4.5 years, ending up at 80.5 on average after 4.5 years. Heel raise height kept improving from 0.5 to 4.5 years, reaching a limb symmetry index of 82.4%. The heel raise work improvement from 0.5 to 1 year did not continue. No significant change was found from 1 to 4.5 years, ending at a limb symmetry index of 60%. CONCLUSION: Early weight-bearing did not influence outcome 4.5 years after nonoperative treatment of acute Achilles tendon rupture. The calf muscle of the injured limb performs 40% less work, when compared to the healthy limb, though lifting height recovers better. LEVEL OF EVIDENCE: II. CLINICAL TRIALS IDENTIFIER: NCT02760784.

Calcium phosphate cement enhances the torsional strength and stiffness of high tibial osteotomies.

PURPOSE: There has been a resurgence in the use of opening wedge high tibial osteotomy (owHTO). Calcium phosphate cement has been shown to improve strength in compression for augmentation of tibial plateau and owHTO fixation. However, knee kinematics includes a torsional load during ambulation, which is as yet unstudied in this model. The purpose of this paper is to investigate the effect of injectable calcium phosphate cement on the biomechanical stability of standard high tibial osteotomy defect with applied torsional load and ultimate stiffness of the supporting construct. METHODS: Testing was performed on 22 bone mineral density-matched and age-matched cadaver specimens. Intact specimens were treated with 10° opening wedge osteotomies, identical surgical techniques as clinically used and fixation provided by iBalance© PEEK implant (Arthrex, Naples FL). Nine specimens were augmented with calcium phosphate injectable cement, Quickset (Arthrex Inc., Naples Fl). Constructs were for construct stiffness, torsional loads to failure, and mechanisms of failure. As a gold-standard comparison group, four samples were tested with a titanium, fixed angle device alone: Contourlock plate (Arthrex Inc., Naples Fl). RESULTS: Peak torque to failure was significantly greater in samples augmented with calcium phosphate bone cement (23.0 ± 9.6 Nm) compared with specimens fixed with PEEK implant alone (18.1 ± 7.3). Construct stiffness in torsion was also significantly improved with bone cement application (349.0 ± 126.8 Nm/°) compared with PEEK implant alone (202.2 ± 153.4 Nm/°) and fixed angle implant system (142.9 ± 74.7 Nm/°). CONCLUSION: Injectable calcium phosphate cement improves the initial maximal torsional strength and stiffness of high tibial osteotomy construct.

Radiological study of the secondary reduction effect of early functional exercise on displaced intra-articular calcaneal fractures after internal compression fixation.

PURPOSE: Early post-operative exercise and weight-bearing activities are found to improve the functional recovery of patients with displaced intra-articular calcaneal fractures (DIACFs). We hypothesized that early functional exercise after surgery might have a secondary reduction effect on the subtalar joint, in particular the smaller fracture fragments that were not fixed firmly. A prospective study was conducted to verify this hypothesis. METHODS: From December 2012 to September 2013, patients with unilateral DIACFs were enrolled and received a treatment consisting of percutaneous leverage and minimally invasive fixation. After surgery, patients in the study group started exercising on days two to three, using partial weight bearing starting week three, and full weight bearing starting week 12. Patients in the control group followed a conventional post-operative protocol of partial weight bearing after week six and full weight bearing after the bone healed. Computed tomography (CT) scanning was performed at post-operative day one, week four, week eight, and week 12 to reconstruct coronal, sagittal, and axial images, on which the maximal residual displacements of the fractures were measured. Function was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring scale at the 12th post-operative month. RESULTS: Twenty-eight patients in the study group and 32 in the control group were followed up for more than 12 months; their data were collected and used for the final analysis. Repeated-measures analysis of variance (ANOVA) of the maximal residual displacements of the fracture measured on CT images revealed significant differences between the study and the control groups. There were interaction effects between group and time point. Except for the first time point, the differences between the groups at all studied time points were significant. In the study group, the differences between all studied time points were significant. Strong correlations were observed between the AOFAS score at post-operative month 12 and the maximal residual displacement of the fractures on the CT images at postoperative week 12. CONCLUSIONS: Early functional exercise and weight bearing activity can smooth and shape the subtalar joint and reduce the residual displacement of the articular surface, improving functional recovery of the affected foot. Therefore, early rehabilitation functional exercise can be recommended in clinical practice.

Full weight bearing after internal fixation of isolated distal fibular fractures with anatomically contoured locking plates: Our institutional experience.

Isolated fractures of the distal fibula mainly affect young, active people. In most cases, fixation is by open reduction with or without casting for six weeks without weight bearing. The current trend is to reduce this period of non-weight-bearing in order to promote earlier functional rehabilitation. The improved mechanical stability resulting from the use of plates with locking screws has changed the postoperative management of many fractures, but there is little evidence for the ankle. Between October 2013 and August 2015, 36 patients were enrolled in a prospective study to evaluate the performance of internal fixation of isolated distal fibular fractures using a lateral anatomically contoured titanium locking plate (InitialA® plate from Newclip Technics, Haute Goulaine, France) with immediate mobilisation and full weight bearing. No patient required further surgery due to mechanical failure or non-union. The bone healing rate was 100 % at 3 months. Two patients had septic complications requiring plate removal and antibiotic treatment and were eventually cured. The use of anatomically contoured locking plates provides strong and stable fixation, allowing immediate full weight-bearing. Such a technique has the advantage of a short recovery time and an early return to work without additional complications.

The effect of early weight-bearing and later weight-bearing rehabilitation interventions on outcomes after ankle fracture surgery: A systematic review and meta-analysis of randomised controlled trials.

OBJECTIVE: This systematic review aimed to analyse the effect of early weight bearing versus late weight bearing on rehabilitation outcomes after ankle fractures, which primarily include ankle function scores, time to return to work/daily life and complication rates. METHODS: The China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, China Science and Technology Journal, Web of Science, PubMed, Embase and Cochrane Library databases were searched. The focus was on identifying randomised controlled trials centred on early weight-bearing interventions for post-operative ankle fracture rehabilitation. All databases were searched for eligible studies published within the period from database inception to 20 June 2023. The eligible studies were screened according to the inclusion criteria. Study quality was evaluated using the methodology recommended by the Cochrane Handbook for the Systematic Evaluation of Interventions. Two authors independently performed the literature search and data extraction. Eligible studies were subjected to meta-analyses using Review Manager 5.3. Based on the time points at which post-operative ankle function was reported in the studies included in this paper, we decided to perform a meta-analysis of ankle function scores at 6 weeks post-operatively, 12 weeks post-operatively, 24-26 weeks post-operatively and 1 year post-operatively. RESULTS: A total of 11 papers, comprising 862 patients, were included. Meta-analysis indicated that patients receiving early weight-bearing interventions, which referred to weight-bearing for 6 weeks post-operatively, experienced enhancements in ankle function scores (Olerud-Molander score, AOFAS score or Baird-Jackson score) at various post-operative milestones: 6 weeks (SMD = 0.69, 95% CI: 0.49-0.88 and p < 0.01), 12 weeks (SMD = 0.57, 95% CI: 0.22-0.92 and p < 0.01) and the 24-26 weeks range (SMD = 0.52, 95% CI: 0.20-0.85 and p < 0.01). The results of subgroup analyses revealed that the effects of early weight-bearing interventions were influenced by ankle range-of-motion exercises. Additionally, early weight bearing allows patients to return to daily life and work earlier, which was evaluated by time when they resumed their preinjury activities (MD = -2.74, 95% CI: -3.46 to -2.02 and p < 0.01), with no distinct elevation in the incidence of complications (RR = 1.49, 95% CI: 0.85-2.61 and p > 0.05). CONCLUSION: The results showed that early weight bearing is effective in improving ankle function among post-operative ankle fracture patients and allows patients to return to daily life earlier. Significantly, the safety profile of early weight bearing remains favourable, with no higher risk of complications than late weight bearing.

Does Early and Late Weight Bearing Have an Effect on the Results of Elderly Tibial Plateau Fractures with Internal Fixation?: A Multicenter (TRON Group) Study.

Introduction: There is still no consensus on the length of the non-bearing period required for tibial plateau fractures (TPFs) treated surgically. Several studies showed that full weight bearing immediately postoperatively does not affect fixation or cause joint collapse in patients with TPF. While there are concerns about weight bearing in the elderly due to fragile bone quality, their physical disability often makes it difficult to carry out activities of daily life when weight bearing is not allowed. The purpose of this study was to assess differences in clinical and radiographic outcomes between an early weight-bearing (EWB) group and a non-weight-bearing (NWB) group following TPF in elderly patients. Material and Methods: We extracted the data of 432 patients who suffered TPF from January 2011 to December 2020 from a database which is named TRON. We excluded patients with insufficient follow-up postoperatively, AO type A/C fracture, age < 60 years old, multiple trauma, and those lost to follow-up. Finally, 91 patients were eligible. EWB group patients were encouraged to perform partial weight-bearing walking at ≤ 4 weeks after surgery, whereas NWB group patients were not allowed weight bearing for > 4 weeks after surgery. Baseline intergroup differences were adjusted for by matching age, sex, body mass index, smoking history, and injury mechanism. We compared Knee Society Score (KSS), timing of full weight bearing, and X-ray findings including step-off, tibia plateau angle, plateau slope, and condylar widening in the X-rays between the two groups. Results: There were no significant statistical differences between the EWB group and NWB group after matching. The mean follow-up period was 28.0 (range 12-73) months. All cases did not require reoperation or additional procedures. The median KSS at 12 months or at the last follow up postoperatively was 100 (77-100) vs. 95 (75-100) points (P = 0.33). There were no differences in fracture-related infection rates or wound dehiscence. In the radiological evaluation of EWB and NWB, the correction loss of condylar widening was only significantly greater for EWB compared to NWB. Conclusions: We found that early weight bearing could contribute to increased condylar widening. While our short-term follow-up didn't reveal any significant clinical differences, this highlights the need for long-term follow-up to comprehensively understand the implications of these radiographic changes.

The feasibility, acceptability, safety, and effects of early weight bearing in humeral fractures - a scoping review.

PURPOSE: Non-weight bearing is often recommended after humeral fractures. This review aims to summarise the extent and nature of the evidence for the feasibility, acceptability, safety, and effects of early weight bearing (EWB) in people with humeral fractures, treated operatively or non-operatively. . METHODS: Data sources identified published (PUBMED, EMBASE, CINAHL) and unpublished (ClinicalTrials.gov, CENTRAL, NIHR Open Research, OpenGrey) literature. Independent data extraction was conducted by two reviewers. RESULTS: 13 901 records were retrieved. Ten studies, involving 515 post-operative patients and 351 healthcare professionals, were included. EWB was found to be feasible in nine studies. There was limited evidence regarding adherence to EWB. Trauma and orthopaedic surgeons reported that EWB was acceptable. This depended on surgery type and whether it was a post-operative polytrauma case. No acceptability data was reported from patients' perspectives. Only one study reported two patients who developed unsatisfactory outcomes from excessive post-operative EWB. Positive effects of EWB were reported on disability level, pain, shoulder and elbow motion, and union. CONCLUSION: There is some evidence for the feasibility, safety, and effectiveness of post-operative EWB after humeral fractures. There was limited data on the acceptability of EWB. Heterogeneous study designs, and variations in EWB protocols limit conclusions.

There is some evidence to support the feasibility, safety, and effectiveness of early weight bearing following operative management of humeral fractures.Early weight bearing after some humeral fractures is acceptable to some subspecialities of orthopaedic surgeons but is not universally accepted.Rehabilitation professionals should discuss the option of early weight bearing after operative management of humeral fracture with patients and their multidisciplinary team.

Prospective randomized comparison of functional bracing versus rigid immobilization with early weightbearing after modified percutaneous achilles tendon repair under local anesthesia.

OBJECTIVE: The optimal treatment and rehabilitation strategy for acute Achilles tendon rupture (ATR) remain a debate. This study aimed to compare the results of the two postoperative regimens after treatment for ATR with modified closed percutaneous repair under local anesthesia. METHODS: In a 4-year study, 72 consecutive patients with acute complete ATR were randomized after percutaneous repair into a functional group (FG), using a modified brace (28 males, three females; mean age 41.9 [29-71] years) and an immobilization group (IG), wearing a rigid plaster (28 males, two females; mean age 42.2 [29-57] years), for a period of 6 weeks. Except for immobilization, they followed the same weight-bearing and rehabilitation protocols. The follow-up period was 3 years. The complication rate, active and passive ankle range of motion, standing heel-rise test, clinical outcome using the American Foot and Ankle Society (AOFAS) hindfoot-ankle score, return to the previous activity level, and subjective assessment were assessed. RESULTS: There was one rerupture in the IG and two transient sural nerve disturbances in the FG and one in the IG, and one suture extrusion in the IG, with no other complications. The average AOFAS scores were 96.9 ± 4.3 and 96.0 ± 4.9 in the FG and IG, respectively. Patients in the FG reached a final range of motion and muscular strength sooner without limping and were more satisfied with the treatment. No significant differences could be detected between groups according to the results in any of the assessed parameters. CONCLUSION: Early dynamic functional bracing in patients with ATR treated with modified closed percutaneous repair under local anesthesia resulted in earlier functional recovery with similar final results in terms of complications and functional outcomes, such as rigid postoperative immobilization with standardized rehabilitation and weight-bearing protocol. LEVEL OF EVIDENCE: I, Prospective randomized study.

Postoperative early weight-bearing using double plating for periprosthetic, interprosthetic, and interimplant distal femur fractures following total knee arthroplasty: A report of three cases.

Background: Distal femur fractures (DFFs) following total knee arthroplasty (TKA) in older patients often require prolonged non-weight-bearing, thereby decreasing their activities of daily living (ADL) and increasing mortality. This report clarifies early weight-bearing safety and utility by using double-plate fixation on medial and lateral sides (LM180 double-plate fixation) for DFFs following TKA. Case presentation: Three cases of Su Type III periprosthetic, interprosthetic, and interimplant DFFs following TKA, where bone stock was limited, were treated with LM180 double-plate fixation using locking plates through medial and lateral incisions on the distal femur. In interprosthetic and interimplant DFF cases, the proximal section was secured by overlapping the lateral plate +/- medial plate with the proximal femur stem of the intramedullary nail by using monocortical screws and cerclage wires. Early postoperative partial weight-bearing was recommended, and full weight-bearing was allowed 4-5 weeks postoperation. All cases regained independent walking without hardware failure. Average ADL scores, namely, Barthel index (BI) and functional independence measure (FIM), were recovered to 85/100 and 114.7/126, respectively, approaching near-normal values. Conclusion: LM180 double-plate fixation for DFFs such as Su Type III periprosthetic, Vancouver type C interprosthetic, and interimplant DFFs following TKA with limited bone stock can be used to achieve early weight-bearing without fixation failure and help maintain ADL.

The effect of early weight-bearing on bone fusion after triple arthrodesis.

Triple arthrodesis is an effective method for treating stiff horseshoe feet and severe osteoarthritis. However, it is still a challenge to improve postoperative bone fusion by changing early weight-bearing. This study improved the classical bone remodeling algorithm, established a mathematical relationship between density change rate and mechanical stimulation, and combined it with finite element theory. The proposed algorithm can not only predict the effect of early weight-bearing on triple arthrodesis but also visually demonstrate the change of bone mineral density with time. The analysis results indicated that 2.5% of the initial load was a potential factor leading to bone nonunion, and 50% of the initial load would result in bone resorption. Meanwhile, it was found that 25% of the external load was more conducive to postoperative rehabilitation. The study results have theoretical significance for enhancing the effect of postoperative bone fusion and formulating a more scientific rehabilitation program, thereby supporting patients' postoperative rehabilitation exercise.

Pulmonary Embolism Post-Femoral Neck Fracture Surgery: A Critical Predictor of Five-Year Mortality.

Objectives: This study examines the impact of pulmonary embolism (PE) on mortality among patients with femoral neck fractures, exploring the predictive value of preoperative PE for postoperative occurrences and associated mortality over a 5-year follow-up period. Methods: We analyzed 2256 patients over 60 years old admitted with femoral neck fractures, focusing on those who developed DVT or PE postoperatively. Surgical intervention aimed within 48 hours without pharmacological thromboprophylaxis, utilizing mechanical prophylaxis instead. Postoperative management included Enoxaparin administration. Data analysis employed SPSS 21, with chi-squared tests, T-tests, and multivariate logistic regression to explore mortality and PE incidence. Results: PE was diagnosed in 1.4% of patients, with a notable mortality contrast between patients with PE (87%) and those without (59.7%) over 5 years. A history of preoperative PE emerged as a significant risk factor for postoperative PE. Despite surgical variations, no significant correlation was found between surgery type and PE incidence. Early postoperative weight-bearing and institutional rehabilitation did not significantly alter PE incidence rates. Conclusions: The study underscores the significant mortality risk associated with preoperative PE in femoral neck fracture patients. It highlights the necessity for vigilant PE risk assessment and management, challenging assumptions about the protective role of early mobility and rehabilitation in PE incidence. Further research is essential to refine patient care strategies and improve outcomes.