Effect Of Early Weight Bearing Research Articles

Trauma

The October 2024 Trauma Roundup360 looks at: Early versus delayed weightbearing following operatively treated ankle fracture (WAX): a non-inferiority, multicentre, randomized controlled trial; The effect of early weightbearing and later weightbearing rehabilitation interventions on outcomes after ankle fracture surgery; Is intramedullary nailing of femoral diaphyseal fractures in the lateral decubitus position as safe and effective as on a traction table?; Periprosthetic fractures of the hip: Back to the Future, Groundhog Day, and horses for courses; Two big bones, one big decision: when to fix bilateral femur fractures; Comparison of ankle fracture fixation using intramedullary fibular nailing versus plate fixation; Unclassified acetabular fractures: do they really exist?

CSP2023: 354 - The feasibility, acceptability, safety, and effects of early weight bearing (EWB) in humeral fractures – a scoping review protocol

CSP2023: 354 - The feasibility, acceptability, safety, and effects of early weight bearing (EWB) in humeral fractures – a scoping review protocol

The feasibility, acceptability, safety, and effects of early weight bearing in humeral fractures – a scoping review

Purpose Non-weight bearing is often recommended after humeral fractures. This review aims to summarise the extent and nature of the evidence for the feasibility, acceptability, safety, and effects of early weight bearing (EWB) in people with humeral fractures, treated operatively or non-operatively. Methods Data sources identified published (PUBMED, EMBASE, CINAHL) and unpublished (ClinicalTrials.gov, CENTRAL, NIHR Open Research, OpenGrey) literature. Independent data extraction was conducted by two reviewers. Results 13 901 records were retrieved. Ten studies, involving 515 post-operative patients and 351 healthcare professionals, were included. EWB was found to be feasible in nine studies. There was limited evidence regarding adherence to EWB. Trauma and orthopaedic surgeons reported that EWB was acceptable. This depended on surgery type and whether it was a post-operative polytrauma case. No acceptability data was reported from patients’ perspectives. Only one study reported two patients who developed unsatisfactory outcomes from excessive post-operative EWB. Positive effects of EWB were reported on disability level, pain, shoulder and elbow motion, and union. Conclusion There is some evidence for the feasibility, safety, and effectiveness of post-operative EWB after humeral fractures. There was limited data on the acceptability of EWB. Heterogeneous study designs, and variations in EWB protocols limit conclusions.

Effect of Early Weight Bearing on Outcomes After Open Reduction and Internal Fixation of Trimalleolar Ankle Fractures

Current practice allows early weight bearing of unstable ankle fractures after fixation. This study offers a unique comparison of early weight bearing (EWB) vs late weight bearing (LWB) in operatively stabilized trimalleolar ankle fractures. The goal of this study was to evaluate union rates, clinical outcomes, and complications for patients who were managed with EWB vs LWB. The authors performed a retrospective review of 185 patients who underwent surgical stabilization for trimalleolar ankle fracture. Fixation of the posterior malleolus and weight bearing status were determined by surgeon preference. For this study, EWB was defined as 3 weeks or less and LWB was defined as greater than 3 weeks. Patients were evaluated for fracture union and implant failure. Complications and clinical outcomes included ambulatory status, infection rate, and return to surgery. The EWB group included 47 (25.4%) patients, and the LWB group included 138 (74.6%) patients. Of the 7 nonunions, 1 (14.3%) occurred in the EWB group and 6 (85.7%) in the LWB group. A total of 72 (38.9%) posterior malleolar fractures were operatively stabilized, and stabilization did not affect union rates. Syndesmotic fixation was required for 12.5% of patients, despite posterior malleolar stabilization. Syndesmotic fixation increased the union rate 2.5 times. Deep infection and open fracture decreased union. No difference was seen between groups in implant failure, union rate, infection, or return to the operating room. No deleterious effect of EWB in operatively treated trimalleolar ankle fractures was found for union, implant failure, infection, or reoperation. Syndesmotic fixation may offer an advantage over posterior malleolar fixation, with improved union rates. [Orthopedics. 2021;44(3):160-165.].

Safety of Early Weight Bearing Following Fixation of Bimalleolar Ankle Fractures.

Ankle fractures are common orthopedic injuries. Although operative indications and subsequent stabilization of these fractures have not significantly changed, postoperative protocols remain highly variable. Effects of early weight bearing (EWB) on fracture characteristics in operatively stabilized bimalleolar and bimalleolar equivalent ankle fractures remain poorly publicized. This study seeks to clarify postoperative fracture union rates, rates of hardware loosening or failure, and radiographic medial clear space changes when comparing EWB to late weight bearing (LWB) following open reduction and internal fixation (ORIF).A total of 95 patients with either bimalleolar (66%) or bimalleolar equivalent (34%) fractures who underwent ORIF were retrospectively reviewed. Weight bearing was allowed at three weeks in the EWB group and when signs of radiographic union were noted in the LWB group. Postoperatively, patients were evaluated at regular intervals for fracture union, signs of implant failure, and evidence of medial clear space widening radiographically.There were 38 patients (40%) in the EWB group and 57 patients (60%) comprising the LWB cohort. There were no significant demographic differences between groups. The EWB group on average began to weight bear at 3.1 + 1.4 weeks postoperatively, whereas the LWB group began at 7.2 + 2.1 weeks postoperatively (p<0.01). Union rate (p=0.51), time to union (p=0.23), and implant failure (p>0.1 at all time intervals) were not notably different between groups. No differences in medial clear space were detected at any postoperative interval between groups (p>0.1 at all time intervals). This study suggests that EWB at three weeks postoperatively does not increase markers of radiographic failure compared to six weeks of non-weight bearing (NWB), which has been regarded as the gold standard of treatment to allow for healing; this may represent an improvement to rehabilitation protocols after bimalleolar ankle ORIF of unstable ankle fractures.

Effects of Early Weight Bearing on Rehabilitation Outcomes in Patients With Traumatic Ankle and Tibial Plateau Fractures

Effects of Early Weight Bearing on Rehabilitation Outcomes in Patients With Traumatic Ankle and Tibial Plateau Fractures

What Variables Influence Final Range of Motion Following Total Ankle Arthroplasty

Category: Ankle Arthritis Introduction/Purpose: While studies have demonstrated a predictable incremental increase in the range of motion (ROM) following total ankle arthroplasty (TAA) it remains unclear what variables affect the post-operative ROM. This study was undertaken to further investigate this question with the goal of providing guidance for patients and surgeons deciding between TAA and arthrodesis. Methods: This is a prospective review of 223 consecutive patients who underwent primary TAA using a single prosthesis performed between 2010-2013 for painful ankle arthritis that failed conservative therapy. Weight bearing flexion and extension X- rays were obtained preoperatively and again at 1 year following surgery. The patients were compared for demographics, type of arthritis, preoperative malalignment, prior trauma, obesity, medical co-morbidities, and the effect of concurrent surgery on post operative ankle ROM. Results: 191 patients had adequate follow-up and met all the inclusion criteria. The preoperative diagnosis, hindfoot or ankle varus or valgus, and concurrent percutaneous tendon Achilles lengthening (TAL) procedures were positive predictors of greater improvement in ankle ROM after TAA. Patients with valgus ankle malalignment had better post TAA DF, PF and total ankle range of motion compared to those in varus (P &lt; 0.05). Percutaneous tendon Achilles lengthening (TAL) improved the DF, but not the PF (P &lt; 0.05). Patients with primary ankle osteoarthritis (n=105) had the best improvement in ROM with an average gain of 3.39° in dorsiflexion (DF), 2.47° in plantar flexion (PF) and 5.84° in total ankle ROM (P &lt; 0.05). An analysis of this subgroup demonstrated greater gain in ankle ROM in patients with lower preoperative ROM compared to those with higher preoperative ankle ROM(P &lt; 0.01). Conclusion: Our results indicated primary ankle OA, preoperative ankle valgus malalignment and intraoperative TAL are significant factors in predicting increased ankle ROM after TAA. Ultimately, ankle motion is a function of the extent of arthritis, fibrosis and the surrounding soft tissue envelope. While TAA restores the function of the joint, it may not adequately correct periarticular fibrosis. Early weight bearing and physical therapy may alleviate postoperative stiffness, and increase the post operative gain in ROM. Further study is underway to determine the effect of early weight bearing and initiation of physical therapy on the ROM following TAA.

Effect of Early Weight Bearing on Knee Joint Strengthening and Balance after Arthroscopic partial Menisectomy in Taekwondo player

Effect of Early Weight Bearing on Knee Joint Strengthening and Balance after Arthroscopic partial Menisectomy in Taekwondo player

Early Weight Bearing of Calcaneal Fractures Fixated With Locked Plates

The use of locked plate technology in the calcaneus has been shown in previous studies to provide greater stability than that of nonlocking plates. The purpose of this study is to examine the radiographic effects of early weight bearing of calcaneal fractures repaired with locked plating. A retrospective review was performed of 17 calcaneal fractures repaired with locked plate fixation over a 2-year period. A chart and radiographic review evaluated the time the patient was kept non-weight bearing and the Bohler's angle at first postoperative visit and final postoperative visit. Change in Bohler's angle was used to evaluate for bone subsidence. Standard reduction and fixation techniques were performed to realign all components of the intra-articular calcaneal fracture using a titanium locking calcaneal fracture plate. Patients returned for follow-up examinations postoperatively and underwent radiographic examination. A weight-bearing short fracture walker boot was applied, and the patient began protected weight bearing at approximately 4 to 5 weeks. The charts and radiographs of 17 intra-articular fractures were reviewed. The average Bohler's angle at first postoperative visit was 30.12° in comparison to the average at final visit of 28.47 °. The average time the patient was kept non-weight bearing after the procedure was 4.8 weeks. The average time of follow-up was 237.7 days. There were no cases of significant bone subsidence or collapse noted. Calcaneal fractures can have significant morbidity associated with the injury and its care. This study examined early weight bearing of calcaneal fractures fixated with locked plating. Under radiographic review, there was no significant loss of calcaneal height, joint reduction, or fixation stability noted. These results are thought to be due to the inherent stability of the locked plate construct.

The Effect of Early Weight Bearing on Migration Pattern of the Uncemented CLS Stem in Total Hip Arthroplasty

Forty-two patients (younger than 65 years) with osteoarthritis were operated on with an uncemented CLS stem and randomized to early unrestricted weight bearing combined with intensive physiotherapy or to partial weight bearing combined with self-training. Radiostereometric analysis showed 1.2 (+0.11 to −6.76) mm subsidence of the stem at 24 months in both groups. There was no significant difference in the migration pattern between the unrestricted and partial weight bearing groups. Actual loading on the operated leg, measured with the F-scan system, did not influence the migration of the stem. There was a strong correlation between the average subsidence at 3 and 24 months ( r = 0.96). Early full weight bearing and active rehabilitation can be used for the uncemented CLS stem without increased risk of early loosening.

Effects of Early Weight Bearing on the Functional Recovery of Ambulatory Children With Cerebral Palsy After Bilateral Proximal Femoral Osteotomy

This study evaluates the effects of early versus delayed weight bearing on the functional recovery of ambulatory children with cerebral palsy (CP) after they have undergone proximal femoral osteotomies (PFOs). We retrospectively reviewed the cases of 25 ambulatory children with CP who underwent PFO to correct excessive hip internal rotation and intoeing. Thirteen children were permitted to weight-bear as tolerated (WBAT) immediately after surgery, and 12 were placed on non-weight bearing restrictions for 3 to 7 weeks (mean +/- SD, 30 +/- 6.7 days). There were no major complications. The children in the WBAT group initiated standing 26 days sooner and returned to baseline walking almost 4 months sooner than those on non-weight bearing restrictions. Pain at 8 days postoperatively was significantly less for the WBAT group, but pain at the time of initial standing and walking was not significantly different between groups. In conclusion, early mobilization after PFOs in children with CP is safe, with reduced recovery time, and with decreased pain.

Early Weight Bearing of Lateral Tibial Plateau Fractures

From 1975 to 1984, 134 consecutive lateral tibial plateau fractures were treated as part of this prospective study. Eighty-six fractures (64%) were followed until union, with an average follow-up period of 22.7 months. The two aims of this study were: First, to analyze the results of operative and nonoperative therapy in each fracture type, and second, to evaluate the effect of early weight bearing in a cast brace in both types of treatment. All lateral tibial plateau fractures with greater than 5 mm depression or displacement were treated operatively. Forty-four patients were treated operatively and 42 patients nonoperatively. All patients were treated with early range of motion and weight bearing in a cast brace. Fractures were initially classified using Hohl's classification system. Overall, 95% of the patients with Type I, II, or V fractures had satisfactory results, as opposed to only 70% of patients with Type III fractures. Of the Type III fractures, 83% treated operatively had satisfactory results compared with 53% treated nonoperatively. Moreover, early weight bearing did not produce further depression greater than 2 mm.