2026 SICOT Annual Meeting: To step or not to step? A prospective randomized trial comparing immediate weight-bearing as tolerated (IWBAT) vs. protected loading in distal femur fractures

Patients with distal femur fractures (AO/OTA 33) were randomized to receive immediate weight-bearing as tolerated (IWBAT) or standard restricted weight-bearing for 6 to 12 weeks following surgical fixation. The number of patients randomized to each group was not reported. The primary outcomes of interest were safety, radiological stability, and clinical recovery. Secondary outcomes included hardware failure, loss of reduction, non-union, Oxford Knee Score (OKS), hospital length of stay, and pulmonary complications. Outcomes were assessed at 3, 6, and 24 months. Overall, the results revealed that IWBAT significantly improved functional recovery at 3 and 6 months (p < 0.01), shortened hospital stays, and reduced minor pulmonary complications without significantly increasing fixation-related complications at 24 months (p > 0.05). These findings suggest that immediate weight-bearing may facilitate recovery without compromising fixation stability in patients with distal femur fractures.