Early Weight Bearing After Lower Extremity Fractures in Adults - PowerPoint PPT Presentation

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Early Weight Bearing After Lower Extremity Fractures in Adults

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Early Weight Bearing After Lower Extremity Fractures in Adults By .Dr samah sami nooh Resident in al hada arm forces hospital Lower extremity fractures are among the ... – PowerPoint PPT presentation

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Title: Early Weight Bearing After Lower Extremity Fractures in Adults


1
Early Weight Bearing After LowerExtremity
Fractures in Adults
  • By .Dr samah sami nooh
  • Resident in al hada arm forces hospital

2
  • Lower extremity fractures are among the most
    common conditions treated by orthopaedic
    surgeons.
  • making appropriate recommendations regarding
    weight bearing is an important clinical issue.
  • Early weight bearing may improve function and
    speed return to work, thus minimizing the
    economic impact of an injury.

3
  • allowing patients to bear weight too soon may
    lead to loss of reduction or fixation failure.
  • Weight-bearing protocols should optimize fracture
    healing while avoiding fracture displacement or
    implant failure.
  • high-quality clinical studies comparing
    weight-bearing protocols after lower extremity
    fractures are not universally available.

4
  • For certain fracture patterns

5
Calcaneus Fractures
  • Paley and Fischgrund treated seven patients with
    ring fixators for a mean of 10 weeks in all
    cases.
  • frame was dynamized 2 weeks before removal
  • Reduction was maintained in six patients and all
    patients ambulated with a cane or crutches for
    the duration of treatment.
  • No heel pain at 2-year follow-up.

6
  • Buckley In a trial of 424 patients with displaced
    intra-articular recommended 6 weeks of nonweight
    bearing followed by physical therapy and
    progressive weight bearing as tolerated for both
    surgically and nonsurgically managed fractures.

7
Ankle Fracture
  • Finsen reported on 56
  • no consistent differences in the functional
    outcomes between the three groups

24 lateral malleolar 10 bimalleolar 22 trimalleolar
early ROM and weight bearing at 6 weeks with no immobilization late ROM and immediate weight bearing as tolerated in a plaster of paris cast late ROM and weight bearing at 6 weeks in a cast
8
Tibial Plafond Fracture
  • There is limited literature on early weight
    bearing after tibial plafond fracture.
  • The current literature is not adequate to enable
    confident comparison of early versus late weight
    bearing after tibial plafond fractures. However,
    most surgeons restrict weigh bearing for at least
    8 to 12 weeks after ORIF

9
Tibial Shaft Fracture
Bridge Plating Closed Treatment Intramedullary Nailing External Fix- ation
Adam 25 pt immediate weight bearing was allowed as tolerated. union average of 9.1 weeks. 1 nonunion 1 infection 1 implant failure 6 valgus malalignment gt5 In a representative series published in 1979, weight bearing at zero to 6 weeks (mean, 22 days) was associated with a faster time to union and no in complication 1,226 in 29 trauma centers reamed or unreamed IM nailing Post hoc analysis found that immediate full weight bearing conferred an increased risk for a postoperative adverse event When dynamization was excluded from the analysis. gt90 of surgeons in the SPRINT trial restricted weight bearing in the immediate postoperative period, which indicates that this was the preferred method of treatment of most surgeons Historically, good results have been reported with immediate weight bearing after external fixation
10
Tibial Plateau Fracture
  • Most surgeons recommend 6 to 8 weeks of
    restricted weight bearing postoperatively to
    prevent fracture displacement in patients with
    tibial plateau fracture.

11
Non locked Buttress Plating Locked Buttress Plating
Segal reported series of 86 Schatzker type 1,2,3 managed surgically or non surgically Both groups were permitted to bear weight as tolerated once the brace was applied No patient in either group had radiographic fracture displacement gt2 mm. In non surgical groups 76 satisfactory outcomes. Surgical group 86 satisfactory outcomes. 32 patients with partial articular proximal tibia Fractures In recent study 12 patients full weight bearing. 20 patient nonweight bearing until 6 to 8 weeks. reported demographic and fracture characteristics were similar between Groups.
12
Femoral Shaft Fractures
Non locked Plating Intramedullary Nailing
We found no studies in which immediate weight bearing was allowed after plating Arazi treated 30 patients with comminuted diaphyseal femur fractures Winquist types II, III, and IV . with IM nailing consisting of a statically locked 12- to 14-mm nail, one oblique 6.4-mm proximal locking screw, and two 6.4-mm distal locking screws All patients were allowed to immediately bear weight as tolerated. All fractures healed without complication
13
Hip Fracture
  • As early as 1961, Garden
  • immediate weight bearing after surgical fixation
    of femoral neck fractures in elderly patients.
    His recommendation has gained considerable
    support in the literature and is widely accepted
    as
  • the standard of care.

14
DHS
  • Koval reported the outcomes of (average age, 79.8
    years) allowed to bear weigh immediately and
    followed for 1 year
  • 280 The rate of revision for loss of fixation was
    2.9.

15
GAM Nil
  • Herrera 551 patient of average age, 82.8 years
  • allowed to bear weight immediately after the
    procedure.
  • The authors reported a 1.4 rate of screw cutout
    and a 4 rate of collapse into secondary varus
    gt10 at final followup.

16
Cancellous Screws
  • Koval 69 patients with nondisplaced femoral
  • neck fractures.
  • The revision rate for loss of fixation or
    nonunion was 4.3 for non displaced and 7.7 for
    displaced femoral neck fractures
  • AVN non displaced, 2.9 displaced, 7.7

17
Acetabular and PelvicFractures
  • literature on early weight bearing after
    acetabular and pelvic fractures is limited.
  • Most surgeons would recommend touch-down weight
    bearing for 6 to 12 weeks postoperatively.

18
Percutaneous Screw Fixation ofAcetabular Fracture
  • Kazemi and Archdeacon In a group of 28 patients
    that included younger patients ( age 49 ) range,
    18 to 83 years managed
  • anterior-column and anterior-column
    posterior-hemitransverse acetabular fractures
    with percutaneous screw fixation and immediate
    full weight bearing

19
  • In immediate full weight bearing .
  • Six patients were lost to follow up.
  • 22 patients were followed for a mean of 39 months
    (range, 12 to 74 months).Radiographic union was
    achieved in all cases, with outcomes graded.
    Excellent in 19 patients, good in 2, and fair in
    1.

Nondisplaced or minimally displaced displaced gt2 mm
6 22
20
Symphyseal Plating for PelvicRing Injuries
  • no study has directly compared weight bearing
    with nonweight bearing in patients with
    surgically treated pelvic ring fractures.
  • Tornetta largest published series reported on 29
    patients with rotationally unstable pelvic
  • injuries that were managed with symphyseal
    plating followed by immediate weight bearing
  • followed for an average of 39 months

21
  • 1 patient had a limp with ambulation (3.4).
  • 4(13.8) showed radiographic failure of the
    symphyseal plate.
  • 3(10.3) had widening of the pubic symphysis
    compared with the immediate postoperative films.
  • No patient required reoperation.

22
Summary
  • High-quality clinical data comparing immediate
    with delayed weight bearing after lower extremity
    fractures is not universally available.
  • certain fracture patterns, there are
    well-designed studies suggesting that patients
    with normal protective sensation can safely bear
    weight sooner after surgical fixation than
    traditional protocols.

23
  • Ankle fractures several randomized controlled
  • Trials shown no difference in clinical and
    radiographic outcomes between patients who are
    allowed to bear weight immediately and those
    whose weight bearing is limited for the first 6
    weeks postoperatively.
  • femoral fractures Retrospective series reported
    low complication rates with immediate weight.

24
  • calcaneal, tibial plafond, tibial plateau, and
    acetabular fractures Most surgeons recommend a
    period of protected weight bearing.

25
  • THANK YOU
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