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OTA 2013: Effect of immediate weight bearing on tibial fracture recovery after IM nailing
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October 2013
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CONFERENCE ACE REPORTS
This ACE Report is a summary of a conference presentation or abstract. The information provided has limited the ability to provide an accurate assessment of the risk of bias or the overall quality. Please interpret the results with caution as trials may be in progress and select results may have been presented.
Synopsis
46 patients with tibial shaft fractures were randomly assigned into 1 of 2 groups to test the effect of immediate weight bearing following intramedullary nailing. One group began weight bearing activities directly after treatment as tolerated while the other group waited 6 weeks before any weight bearing occurred. Results demonstrated that immediate weight bearing following intramedullary nailing of tibial shaft fractures does not increase complication rate, or negatively affect time to union.
Publication Funding Details
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Funding:
Non-Industry funded
Sponsor:
Orthopaedic Trauma Association
Conflicts:
None disclosed
Why was this study needed now?
In current orthopaedic treatment there is no agreement regarding the appropriate postoperative weight-bearing status following the intramedullary (IM) nailing of tibial shaft fractures. This study was brought forward to examine the potential benefits and risks associated with immediate postoperative weight bearing when compared to no weight bearing for the first 6 postoperative weeks.
What was the principal research question?
Does immediate postoperative weight bearing following the intramedullary nailing of tibial shaft fractures result in equivalent clinical outcomes when compared to no weight bearing for 6 weeks following completion of the operation?
Study Characteristics
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Population:
46 patients with tibial shaft fractures.
Intervention:
WBAT Group: Patients in this group began weight bearing activities immediately after treatment as tolerated.
Comparison:
NWB Group: Patients in this group did not participate in any weight bearing activities for the first 6 postoperative weeks.
Outcomes:
Outcomes assessed were: Radiographs, the short musculoskeletal function assessment (SMFA) questionnaire, and complications.
Methods:
RCT: Prospective
Time:
Patients were followed until union or until treatment failure/revision surgery
What were the important findings?
- The WBAT and NWB groups did not differ in terms of demographics, ISS, open/closed fracture status, or fracture pattern.
- No difference in observed time to union was found between groups (p>0.05).
- Complication rates for hardware failure and delayed/ nonunion were comparable between the groups (p>0.05).
- No incidents, in either group, of significant loss of reduction leading to malunion were found.
- SMFA scores for all domains were similar between the groups at 6 weeks postoperative follow up and at time of union.
What should I remember most?
No differences were found between groups with regards to complication rate, union rate, or SMFA score. Neither postoperative treatment method resulted in a significant loss of reduction that lead to malunion.
How will this affect the care of my patients?
Immediate weight bearing following intramedullary nailing of tibial shaft fractures does not increase the incidence of adverse events or complications following fractured tibial shaft treatment. Further research should be completed regarding the possible benefits immediate weight beading might have on patients recovering from tibial shaft fractures.
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