Some Elderly Fracture Patients OK for Immediate Weightbearing

New research from Indiana University School of Medicine Methodist Hospital in Indianapolis has found evidence that, for selected elderly patients, immediate weight bearing following distal femur fractures may be acceptable.

Their study, “Is Immediate Weight-Bearing Safe After Single Implant Fixation of Elderly Distal Femur Fractures?” was published in the January 2021 edition of the Journal of Orthopaedic Trauma.

Greg Gaski, M.D., an orthopedic trauma surgeon now with Inova Fairfax Medical Campus in Falls Church, Virginia, was a co-author on the study. He explained both the incidence rates and typical surgical repair for elderly fracture patients to OTW, “The incidence of elderly distal femur fractures is on the rise. These injuries typically require surgical repair and patients are traditionally instructed to not place weight on the leg for a period of 6-12 weeks (‘non-weightbearing’).”

“There is ample evidence that early weightbearing immediately after surgery in patients with hip fractures improves outcomes such as earlier discharge from the hospital, quicker rehabilitation period, and less medical complications including pneumonia, skin ulcers, blood clots and death.”

“With recent advances in surgical techniques and fixation for distal femur fractures, including modern intramedullary nails and locking plates, we believe that patients can often be permitted to bear weight on the leg right after surgery similar to patients with hip fractures with similar rates of healing and without adverse consequences. We also postulated that distal femur fracture patients would see similar systemic benefits from this protocol as hip fracture patients such as earlier discharge from the hospital.”

The researchers looked at 135 patients 60 years or older who had surgical fixation of an extra-articular distal femur fracture and periprosthetic fractures with a stable knee prosthesis.

One group was allowed “weight-bearing as tolerated” immediately postoperatively. The other group—those prescribed “touchdown weight-bearing”—was instructed to “not place weight through the affected extremity, but the patient was allowed to touch the foot to the ground for balance.” These patients were prescribed “touchdown weight-bearing” for six weeks postoperatively followed by unrestricted “weight-bearing as tolerated.”

Few Differences Between Groups

Dr. Gaski summarized the study results to OTW, “We compared 56 patients that were allowed to bear weight immediately to 79 patients that were not allowed to bear weight (‘touchdown weightbearing’) and found similar rates of healing and no difference in adverse events between the groups.”

“Eleven percent of patients in the early weightbearing group had a second surgery compared to 19% in the touchdown weightbearing group which was not a statistically significant difference. We found that 20% of early weightbearing patients were discharged home and 80% went to a nursing facility or rehabilitation center compared to only 10% of touchdown weightbearing patients that went home. The average hospital length of stay in patients with isolated distal femur fractures was 5.3 days in the early weightbearing group and 5.7 days days in the touchdown group (no difference).”

“This work demonstrates that most elderly patients with distal femur fractures may safely be prescribed ‘weightbearing as tolerated’ after surgery without concern for adverse effects on bone healing and complications. Larger prospective studies with greater patient enrollment may better assess potential benefits of early weightbearing on functional outcome, complications, and hospital length of stay similar to the hip fracture population.”