OTA 2013: Effect of immediate weight bearing on tibial fracture recovery after IM nailing
Can All Tibial Shaft Fractures Bear Weight Following Intramedullary Nailing? A Randomized Clinical Trial
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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.
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?
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.