Is immediate weight bearing safe for subtrochanteric femur fractures in elderly patients treated by cephalomedullary nailing? A multicentric study in one hundred eighty-two patients.

Autor: SanJosé-Pardo I; Orthopedic and Traumatology Department, Complejo Asistencial Universitario de Palencia, Avenida Donantes de sangre S/N, 34005, Palencia, Spain. inigosanjose21@gmail.com., Valle-Cruz JA; Orthopedic and Traumatology Department, Hospital Clínico San Carlos, Calle Profesor Martín Lagos, 2, 28040, Madrid, Spain., Donadeu-Sánchez S; Orthopedic and Traumatology Department, Hospital Clínico San Carlos, Calle Profesor Martín Lagos, 2, 28040, Madrid, Spain., Aguado HJ; Orthopedic and Traumatology Department, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal 3, 47003, Valladolid, Spain., País-Ortega S; Orthopedic and Traumatology Department, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal 3, 47003, Valladolid, Spain., Montoya-Adarraga J; Orthopedic and Traumatology Department, Hospital Universitario Infanta Leonor, Avenida Gran Vía del Este 80, 28031, Madrid, Spain., Díez-Rodríguez Á; Orthopedic and Traumatology Department, Hospital Universitario Infanta Leonor, Avenida Gran Vía del Este 80, 28031, Madrid, Spain., Alonso Del Olmo JA; Orthopedic and Traumatology Department, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal 3, 47003, Valladolid, Spain., Mingo-Robinet J; Orthopedic and Traumatology Department, Complejo Asistencial Universitario de Palencia, Avenida Donantes de sangre S/N, 34005, Palencia, Spain.
Jazyk: angličtina
Zdroj: European journal of orthopaedic surgery & traumatology : orthopedie traumatologie [Eur J Orthop Surg Traumatol] 2024 Jul; Vol. 34 (5), pp. 2595-2603. Date of Electronic Publication: 2024 May 04.
DOI: 10.1007/s00590-024-03897-8
Abstrakt: Purpose: Biomechanical superiority of intramedullary nails over extramedullary implants has been proved for subtrochanteric fractures. Nevertheless, postoperative management of these patients has not changed, with high rates of protected weight-bearing after intramedullary nailing. The purpose of this study is to determine the mechanical complications of immediate postoperative full weigh-bearing for subtrochanteric femur fractures in elderly patients treated with a cephalomedullary nail.
Methods: We performed a retrospective case series study from patients treated with a cephalomedullary nail for subtrochanteric fractures (AO/OTA 31A.3 and 32A-32C) over a nine-year period. Patients in the immediate full weight-bearing (IFWB) group received orders for immediate full weight bear as tolerated on postoperative 48 h. Patients in the non- or limited- weight-bearing (NLWB) group received orders not to full weight bear in the immediate postoperative.
Results: There were five (2.7%) cases of implant failure including four cutouts and one nail breakage that needed a reoperation. Of them, one (2.2%) followed the NLWB protocol and four (2.9%) followed the IFWB protocol. Mean length of stay was 7.9 days (median 8, range 3-21) in the NLWB group and 10.7 days (median 8, range 2-60) in the IWBAT group. The NLWB group observed a 2.8-day shorter postoperative length of stay when compared to the IFWB, but the median remained equal.
Conclusion: This study suggests that geriatric patients with subtrochanteric fractures treated by intramedullary nailing and in which a good fracture reduction was achieved, may be able to tolerate immediate postoperative full weight-bearing, not increasing reoperation rates due to implant failure.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)
Databáze: MEDLINE
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