Immediate weight bearing as tolerated (WBAT) correlates with a decreased length of stay post intramedullary fixation for subtrochanteric fractures: a multicenter retrospective cohort study.

Autor: Cunningham BP; Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA. Brian.P.Cunningham@HealthPartners.com.; TRIA Orthopaedics, Bloomington, MN, USA. Brian.P.Cunningham@HealthPartners.com.; Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA. Brian.P.Cunningham@HealthPartners.com.; Saint Paul, MN, 55101, USA. Brian.P.Cunningham@HealthPartners.com., Ali A; Florida Orthopaedic Institute, Tampa, FL, USA., Parikh HR; Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA., Heare A; Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.; Department of Orthopaedic Surgery, University of Miami Health System, Miami, FL, USA., Blaschke B; Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA.; TRIA Orthopaedics, Bloomington, MN, USA., Zaman S; Department of Orthopaedics, Loma Linda University Medical Center, Loma Linda, CA, USA., Montalvo R; Department of Orthopaedics, R Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MA, USA., Reahl B; Department of Orthopaedic Surgery, University of Washington School of Medicine, Seattle, WA, USA., Rotuno G; Department of Orthopaedic Surgery, University of South Florida College of Medicine, Tampa, FL, USA., Kark J; Department of Orthopaedic Surgery, University of Washington School of Medicine, Seattle, WA, USA., Bender M; Department of Orthopaedic Surgery, University of South Florida College of Medicine, Tampa, FL, USA., Miller B; Department of Orthopaedic Trauma, Sonoran Orthopaedic Trauma Surgeons, Scottsdale, AZ, USA., Basmajian H; Department of Orthopaedics, Loma Linda University Medical Center, Loma Linda, CA, USA., McLemore R; Clinical Outcomes and Data Engineering Technology, Phoenix, AZ, USA., Shearer DW; Department of Orthopaedic Surgery, San Francisco General Hospital, University of CA - San Francisco, San Francisco, CA, USA., Obremskey W; Department of Orthopaedics, Vanderbilt University, Nashville, TN, USA., Sagi C; Department of Orthopaedic Surgery, Harborview Medical Center, Seattle, WA, USA.; Department of Orthopaedic Trauma, University of Cincinnati, Cincinnati, OH, USA., O'Toole RV; Department of Orthopaedics, R Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MA, USA.
Jazyk: angličtina
Zdroj: European journal of orthopaedic surgery & traumatology : orthopedie traumatologie [Eur J Orthop Surg Traumatol] 2021 Feb; Vol. 31 (2), pp. 235-243. Date of Electronic Publication: 2020 Aug 14.
DOI: 10.1007/s00590-020-02759-3
Abstrakt: Background: Subtrochanteric femur fractures associate with a relatively high complication rate and are traditionally treated operatively with a period of limited weight bearing. Transitioning from extramedullary to intramedullary implants, there are increasing biomechanical and clinical data to support early weight bearing. This multicenter retrospective study examines the effect of postoperative weight bearing as tolerated (WBAT) for subtrochanteric femur fractures. We hypothesize that WBAT will result in a decreased length of stay (LOS) without increasing the incidence of re-operation.
Methods: This study assesses total LOS and postoperative LOS after intramedullary fixation for subtrochanteric fractures between postoperative weight bearing protocols across 6 level I trauma centers (n = 441). Analysis techniques consisted of multivariable linear regression and nonparametric comparative tests. Additional subanalyses were performed, targeting mechanism of injury (MOI), Winquist-Hansen fracture comminution, 20-year age strata, and injury severity score (ISS).
Results: Total LOS was shorter in WBAT protocol within the overall sample (7.4 vs 9.7 days; p < 0.01). Rates of re-operation were similar between the two groups (10.6% vs 10.5%; p = 0.99). Stratified analysis identified patients between ages 41-80, WH comminution 2-3, high MOI, and ISS between 6-15 and 21-25 to demonstrate a significant reduction in LOS as a response to WBAT.
Conclusion: An immediate postoperative weight bearing as tolerated protocol in patients with subtrochanteric fractures reduced length of hospital stay with no significant difference in reoperation and complication rates. If no contraindication exists, immediate weight bearing as tolerated should be considered for patients with subtrochanteric femur fractures treated with statically locked intramedullary nails.
Level of Evidence: Therapeutic Level III.
Databáze: MEDLINE
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