Non-weight-bearing Group Research Articles

Does Early and Late Weight Bearing Have an Effect on the Results of Elderly Tibial Plateau Fractures with Internal Fixation?: A Multicenter (TRON Group) Study.

There is still no consensus on the length of the non-bearing period required for tibial plateau fractures (TPFs) treated surgically. Several studies showed that full weight bearing immediately postoperatively does not affect fixation or cause joint collapse in patients with TPF. While there are concerns about weight bearing in the elderly due to fragile bone quality, their physical disability often makes it difficult to carry out activities of daily life when weight bearing is not allowed. The purpose of this study was to assess differences in clinical and radiographic outcomes between an early weight-bearing (EWB) group and a non-weight-bearing (NWB) group following TPF in elderly patients. We extracted the data of 432 patients who suffered TPF from January 2011 to December 2020 from a database which is named TRON. We excluded patients with insufficient follow-up postoperatively, AO type A/C fracture, age < 60years old, multiple trauma, and those lost to follow-up. Finally, 91 patients were eligible. EWB group patients were encouraged to perform partial weight-bearing walking at ≤ 4weeks after surgery, whereas NWB group patients were not allowed weight bearing for > 4weeks after surgery. Baseline intergroup differences were adjusted for by matching age, sex, body mass index, smoking history, and injury mechanism. We compared Knee Society Score (KSS), timing of full weight bearing, and X-ray findings including step-off, tibia plateau angle, plateau slope, and condylar widening in the X-rays between the two groups. There were no significant statistical differences between the EWB group and NWB group after matching. The mean follow-up period was 28.0 (range 12-73) months. All cases did not require reoperation or additional procedures. The median KSS at 12months or at the last follow up postoperatively was 100 (77-100) vs. 95 (75-100) points (P = 0.33). There were no differences in fracture-related infection rates or wound dehiscence. In the radiological evaluation of EWB and NWB, the correction loss of condylar widening was only significantly greater for EWB compared to NWB. We found that early weight bearing could contribute to increased condylar widening. While our short-term follow-up didn't reveal any significant clinical differences, this highlights the need for long-term follow-up to comprehensively understand the implications of these radiographic changes.

Early versus Standard Weight Bearing Following Operative Treatment of Tibial Plateau Fractures: Do We Really Have to Wait So Long?

Postoperative management of tibial plateau fractures classically involves a prolonged period between 10 and 12 weeks of nonweight bearing or partial weight bearing. In recent years, there has been some support for earlier weight-bearing protocols although this remains controversial. The goal of this study was to investigate the difference in outcomes between early weight-bearing (EWB) and traditional weight-bearing (TWB) protocols. This investigation is a retrospective review of 92 patients treated with open reduction and internal fixation of tibial plateau fractures at a single institution, from August 2018 to September 2020. Subjects were divided into EWB (< 10 weeks) and traditional nonweight bearing groups (≥ 10 weeks). Key outcome measures collected include injury classification, mechanism of injury, surgical fixation method, bone grafting, time to full weight bearing, radiographic time to union, range-of-motion, all-cause complications, and subsidence at an average follow-up time of 1 year. The EWB group had an earlier average time to weight bearing versus the TWB group (6.5 ± 1.4 vs. 11.8 ± 2.3 weeks, p < 0.0001). There was no difference in the classification of fractures treated between the two groups, with Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association B3 fractures the most common in the EWB group, and C3 fractures the most common in the TWB group. Radiographic time to union was no different between the two groups (93.5 ± 53.7 days for EWB vs. 103.7 ± 77.6 days for TWB, p = 0.49). There was no significant difference in complication rates or subsidence. Following operative treatment of tibial plateau fractures, patients who underwent a weight-bearing protocol earlier than 10 weeks were able to recover faster with similar outcomes and complications compared with patients who started weight bearing after 10 weeks or more. LEVEL OF EVIDENCE: III.

MP52-02 CYSTATIN C IS MORE SENSITIVE THAN CREATININE IN DETECTION OF KIDNEY DYSFUNCTION IN NON-WEIGHT-BEARING INDIVIDUALS

You have accessJournal of UrologyCME1 Apr 2023MP52-02 CYSTATIN C IS MORE SENSITIVE THAN CREATININE IN DETECTION OF KIDNEY DYSFUNCTION IN NON-WEIGHT-BEARING INDIVIDUALS Glenn Werneburg, Daniel Hettel, Stacy Jeong, Gregory Nemunaitis, Jonathan Taliercio, and Hadley Wood Glenn WerneburgGlenn Werneburg More articles by this author , Daniel HettelDaniel Hettel More articles by this author , Stacy JeongStacy Jeong More articles by this author , Gregory NemunaitisGregory Nemunaitis More articles by this author , Jonathan TaliercioJonathan Taliercio More articles by this author , and Hadley WoodHadley Wood More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003300.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Individuals with neurological disorders and neurogenic lower urinary tract dysfunction are often non-weight-bearing (NWB) with lower muscle mass than the general population. We sought to compare eGFR equations that include creatinine, cystatin C, or both, in NWB individuals and matched ambulatory controls. METHODS: Electronic medical records were reviewed for individuals with serum creatinine (Cr) and cystatin C (cys) and diagnosis consistent with NWB status, and ambulatory controls matched by age, race, sex, kidney function, diabetes, and hypertension. 2021 CKD-EPI race agnostic equations were used to calculate eGFR. Demographics and renal function were compared in the overall cohorts and in a patient subset with imaging and/or urinalysis evidence of renal dysfunction. Patients who were classified into a new eGFR category based on the incorporation of cystatin C were determined. eGFR classifications reflected those used in chronic kidney disease staging: CKD stage 1 ≥90 mL/min/1.73 m2, CKD stage 2 60-89 mL/min/1.73 m2, CKD stage 3 30-59 mL/min/1.73 m2, CKD stage 4 15-29 mL/min/1.73 m2, and CKD stage 5 <15 mL/min/1.73 m2. RESULTS: In the NWB population (n=102), eGFR differed significantly when calculated using CKD-EPICr, CKD-EPICr+Cys and CKD-EPICys (107, 93, 80 mL/min/1.73 m2, respectively, p<0.001). The differences in eGFR were greater in the NWB group relative to the control group (n=204) regardless of CKD-EPI equation pairs compared (p<0.001, Table 1). In the patient subset with imaging and/or proteinuria evidence of renal dysfunction, the NWB population again had different eGFR when calculated using the CKD-EPICr, CKD-EPICr+Cys and CKD-EPICys equations (102, 86, 71 mL/min/1.73 m2, respectively, p<0.001). Fifty-eight percent of NWB individuals with evidence of renal dysfunction on imaging or urinalysis were reclassified into a category of lower eGFR (corresponding to CKD stage) when using eGFRCys relative to eGFRCr. CONCLUSIONS: eGFR equations containing serum creatinine, cystatin C, or both, validated in mostly ambulatory populations, are not equivalently accurate in estimating kidney function in NWB individuals. Comparison of these equations against gold standard GFR measurement is needed to determine which most closely approximates true GFR. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e702 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Glenn Werneburg More articles by this author Daniel Hettel More articles by this author Stacy Jeong More articles by this author Gregory Nemunaitis More articles by this author Jonathan Taliercio More articles by this author Hadley Wood More articles by this author Expand All Advertisement PDF downloadLoading ...

A non-weight bearing protocol after ACL reconstruction improves static anterior tibial translation in patients with elevated slope and increased weight bearing tibial anterior translation

PurposeAim of this study is to evaluate the impact of a non-weight bearing (NWB) protocol within 21 post-operative days after anterior cruciate ligament (ACL) reconstruction on static and dynamic anterior tibial translations (SATT and DATT, respectively). The hypothesis is that delayed WB would improve ATT at 9 months follow-up.MethodsA series of patients treated with ACL reconstruction was retrospectively reviewed, comparing a group with immediate post-operative weight bearing (WB group) and a group without post-operative weight bearing (NWB group). The NWB protocol was applied to patients with posterior tibial slope (PTS) ≥ 12°, pre-operative SATT ≥ 5 mm, and/or meniscal lesions of root or radial type. SATT, and PTS were measured on 20° flexion monopodal lateral x-rays, while DATT on Telos™ x-rays at pre-operative and 9-months follow-up.ResultsOne hundred seventy-nine patients were included (50 NWB group, 129 WB group). The SATT worsened in the WB group with a mean increase of 0.7 mm (SD 3.1 mm), while in the NWB group, the SATT improved with a mean decrease of 1.4 mm (SD 3.1 mm) from the pre-operative to 9 months’ follow-up (p < 0.001). The side-to-side Telos™ evaluation showed a significant improvement in DATT within both the groups (p < 0.001), but there was no difference between the two groups (p = 0.99).ConclusionThe post-operative protocol of 21 days without WB led to an improvement in SATT at 9 months without an influence on DATT, and it is recommended for patients with a SATT ≥ 5 mm and/or a PTS ≥ 12° as part of an “à la carte” approach to ACL reconstruction.Level of evidenceLevel IV, Retrospective case series

To Be(Ar) Or Not to Be(Ar) – Jones Dilemma?

Category:Midfoot/ForefootIntroduction/Purpose:Jones fracture is the fracture of the base of 5th metatarsal and is a commonly encountered in the clinical setting. Its management has always been a subject of great debate with paucity of consensus on post- operative weight bearing protocols. We aim to evaluate the efficacy of early weight bearing in the post-operative management of Jones fracture and assess its association with radiological union and patient reported outcomes.Methods:Retrospectively, patients undergoing fixation of Jones fracture from January 2011 to December 2020 were identified. Radiographic follow-up of at least 8 weeks was required for inclusion yielding 40 patients. Patients were grouped by early weight bearing (EWB) as tolerated (26 patients) and non-weight bearing (NWB) for 2 weeks followed by partial weight bearing (14 patients). Medical records were reviewed for demographic variables, associated comorbidities, type of surgical construct used, fracture type, mode of injury and union. Delayed union was defined as patients without radiographic evidence of union at 12.5 weeks. Patients completed PROMIS physical function, PROMIS pain interference, and FFI scoring postoperatively.Results:The mean age was 42.83+- 17.03 years with a female gender predominance (n=23; 57.5%) and an average BMI of 32.2 +- 8.7. Thirteen (50%) in the EWB and 5 (43%) in NWB groups experienced delayed radiological union (>12 weeks) and this did not differ by group. There was one nonunion in the NWB group and none in the EWB group. The number of wound complications did not vary by group. Seventeen patients completed postoperative FFI and PROMIS scores at a median of 40 months (41.5 IQR). The FFI and PROMIS scores did not differ by group. In the EWB group, the median PROMIS scores were physical function 43.7 (6.7 (IQR)) and pain interference 52.8 (10.1) compared to physical function 44.0 (11.6) and pain interference 55.2 (11.8) in the NWB group. The median total FFI score in the EWB group was 20.0 (27) compared to 32 (32) in the NWB group.Conclusion:The EWB group exhibited comparable results to the NWB group after surgical fixation of Jones fracture. Importantly, PROMIS scores indicate both groups had comparable functional outcomes at long term follow up and were within a standard deviation of the general population of the United States (Score of 50 with SD of 10) for both pain and function. While further investigation is required, EWB may have equivocal results in terms of union, wound complications, and functional outcomes while allowing for early mobilization after Jones fracture fixation.

Weight-bearing status may influence rates of radiographic healing following reamed, intramedullary fixation of diaphyseal femur fractures.

Objective:To investigate the effect of weight-bearing status on radiographic healing of diaphyseal femur fractures.Design:Retrospective 1:1 matched cohort study.Setting:Single-level 1 trauma center.Participants:One-hundred forty-four (N = 154) patients matched 1:1 in non-weight bearing (NWB) and weight-bearing as tolerated (WBAT) groups.Intervention:Non-weight bearing following reamed, statically locked intramedullary fixation of diaphyseal femur fracture, generally due to concurrent lower extremity fracture.Main Outcome Measurement:Postoperative radiographic healing using modified Radiographic Union Scale for Tibia fractures (mRUST) scores.Results:Groups were well matched on age, sex, race, prevalence of tobacco and alcohol use, diabetes mellitus status, Injury Severity Score, fracture pattern and shaft location, vascular injury, open fracture prevalence, and operative characteristics. Radiographic follow-up was similar between groups (231 vs 228 days, P = .914). At 6 to 8 weeks status post intramedullary fixation, the median mRUST score in the NWB group (9) was lower than that of the WBAT group (10) (mean: 8.4 vs 9.7, P = .004). At 12 to 16 weeks, the median mRUST in the NWB group (10) was again lower than the WBAT group (12) (mean: 9.9 vs 11.7, P = .003). The median number of days to 3 cortices of bridging callous was 85 in the WBAT group, compared with 122 in the NWB group (P = .029). Median time to mRUST scores of 12 (111 vs 162 days, P = .008), 13 (218 vs 278 days, P = .023), and 14 (255 vs 320 days, P = .028) were all longer in the NWB group compared with the WBAT group.Conclusions:Non-weight bearing after intramedullary fixation of diaphyseal femur fractures delays radiographic healing, with median time to 3 cortices of bridging callous increased from 85 days in WBAT groups to 122 days in NWB groups. These results provide clinicians with an understanding of the expected postoperative course, as well as further support the need to expeditiously advance weight-bearing status.Level of Evidence: IV

Impact of Early Weightbearing After Ankle Arthroscopy and Bone Marrow Stimulation for Osteochondral Lesions of the Talus.

Background:Osteochondral lesion of the talus (OLT) may be caused by osteochondritis dissecans, osteochondral fractures, avascular necrosis, or focal arthritic changes. For certain focal cartilage defects, bone marrow stimulation (BMS) has been a widely used technique to restore a fibrocartilage substitute overlying the defect. There are various postoperative weightbearing protocols for this procedure, with no single gold standard method.Purpose:To retrospectively review the outcomes of patients undergoing ankle arthroscopy with concomitant BMS to determine outcomes based on postoperative weightbearing status.Study Design:Cohort study; Level of evidence, 3.Methods:We retrospectively reviewed the records of patients who underwent ankle arthroscopy with BMS for OLTs between 2015 and 2018. Patients were placed into 2 cohorts based on postoperative immobilization status: the nonweightbearing (NWB) group and the weightbearing-as-tolerated (WBAT) group. Patient characteristics obtained included age, sex, comorbidities, and etiology of talar pathology. Outcomes included the pain visual analog scale (VAS), range of motion (ROM), complications, time to first weightbearing, and the method and length of immobilization. Patients who were lost to follow-up before 30 days were excluded. The chi-square test was used to compare categorical variables between cohorts, and the t test was used for continuous variables.Results:A total of 69 patients met the inclusion criteria for this study, 18 in the WBAT group and 51 in the NWB group. The mean lesion size was 9.48 × 9.21 mm (range, 3-15 mm × 2-20 mm) for the NWB group and 9.36 × 9.72 mm (range, 5-14 mm × 6-20 mm) for the WBAT group (P > .05). The VAS scores improved from 4.40 to 0.67 for the WBAT group and from 6.33 to 2.55 for the NWB group, with the difference in final values reaching statistical significance (P = .0002). Postoperative ROM was not significantly different between the groups. There were 4 repeat operations within the NWB cohort.Conclusion:The surgical management of OLTs can be challenging, and the postoperative weightbearing protocol can be an extra obstacle for the patient to navigate. We found no difference in pain, ROM, or complications when allowing immediate, full WBAT.

Early Weightbearing Versus Nonweightbearing After Operative Treatment of an Ankle Fracture: A Multicenter, Noninferiority, Randomized Controlled Trial

Background: Acute ankle fractures can occur during sports activities, and unstable ankle fractures are commonly treated operatively. However, controversy exists about the optimal time to allow weightbearing. Hypothesis: Early weightbearing after the stable fixation of an ankle fracture is not inferior to nonweightbearing in terms of ankle function assessed at 12 months after injury. Study design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 258 patients were assessed for eligibility. Of these patients, 194 were randomly allocated to either the early weightbearing group (95 patients who were allowed weightbearing at 2 weeks postoperatively) or the nonweightbearing group (99 patients who were not allowed weightbearing until 6 weeks postoperatively). The primary outcome measure was the mean difference in the Olerud-Molander ankle score (OMAS) between the groups, assessed at the 12-month follow-up examination. The secondary outcome measures were the time to return to preinjury activities and patients’ subjective satisfaction. Complications such as hardware loosening or failure, fracture displacement, and nonunion were evaluated. Results: The mean difference in the OMAS for the early weightbearing group compared with the nonweightbearing group was 1.6 (95% CI, –1.9 to 5.0) in the intention-to-treat analysis. The lower limit of the 95% CI (–1.9) exceeded the noninferiority margin of –8, indicating that early weightbearing was not inferior to nonweightbearing. The difference in the proportion of patients who were satisfied or very satisfied with their treatment was not statistically significant (84.3% vs 76.2%; P = .19); however, the time taken to return to preinjury activities was shorter with early weightbearing than with nonweightbearing (9.1 ± 3.0 vs 11.0 ± 3.0 weeks; P < .001). No cases of nonunion were observed in either group. Conclusion: Early weightbearing after the operative treatment of an unstable ankle fracture was not inferior to nonweightbearing in terms of OMAS assessed at 12 months after injury. The patients’ subjective satisfaction was similar between the groups, although the time taken to return to preinjury activities was shorter in the early weightbearing group. Registration: NCT02029170 (ClinicalTrials.gov identifier).

Minimally Invasive Necrotic Bone Washing Improves Bone Healing After Femoral Head Ischemic Osteonecrosis: An Experimental Investigation in Immature Pigs.

Ischemic osteonecrosis of the femoral head produces necrotic cell debris and inflammatory molecules in the marrow space, which elicit a chronic inflammatory repair response. The purpose of this study was to determine the effects of flushing out the necrotic cell debris and inflammatory proteins on bone repair in a piglet model of ischemic osteonecrosis. Osteonecrosis of the femoral head of the right hindlimb was induced in 12 piglets by tying a ligature tightly around the femoral neck. One week after the surgery, 6 animals were treated with a percutaneous 3-needle bone washing procedure and non-weight-bearing (NWB) of the right hindlimb (wash group). The total saline solution wash volume was 450 mL per femoral head. Serial wash solutions were collected and analyzed. The remaining 6 animals were treated with NWB only (NWB group). At 8 weeks after the surgery, the femoral heads were assessed using radiography, micro-computed tomography (micro-CT), and histological analysis. In addition, we compared the results for these piglets with our published results for 6 piglets treated with multiple epiphyseal drilling (MED) plus NWB without bone washing (MED group). Necrotic cells and inflammatory proteins were present in the bone wash solution collected 1 week after ischemia induction. The protein and triglyceride concentrations decreased significantly with subsequent washing (p < 0.005). At 8 weeks after ischemia induction, the wash group had a significantly higher bone volume than the MED or NWB group (p < 0.0001). Histological bone-formation measures were also significantly increased in the wash group compared with the MED group (p = 0.002) or NWB group (p < 0.0001) while macrophage numbers were significantly decreased in the wash group. The percutaneous 3-needle procedure flushed out cell debris and inflammatory proteins from the necrotic femoral heads, decreased osteoclasts and macrophages, and increased bone formation following induction of ischemic osteonecrosis. We believe that this is the first study to investigate the concept of washing out the necrotic femoral head to improve bone healing. The minimally invasive procedure may be useful to improve the necrotic bone environment and bone repair following ischemic osteonecrosis.

Do levels of sedentary behaviour and physical activity differ according to weight-bearing status after lower limb fracture? A prospective cohort study

Background/purpose: To determine whether sedentary behaviour and physical activity differ according to initial weight-bearing status 2 weeks and 6 months after lower limb (LL) fracture. Methods: Two weeks and 6 months following LL fracture, 47 adults aged 18–69 wore ActiGraph and activPAL accelerometers for 10 days. Sitting time, steps, and moderate-intensity physical activity (MPA) were compared between weight-bearing (WB) and non-weight-bearing (NWB) groups. Results: Two weeks post-discharge, the NWB group sat significantly more than the WB group (median: 14.1 h/day vs. 13.3 h/day; p = 0.04). These differences were apparent for female and middle-aged participants. At 6 months, there were no significant differences between weight-bearing groups for sitting time, steps or MPA. Conclusion: Weight-bearing restriction had an early impact on sitting time, but this impact lessened over time. While considering the need for rest, advice about reducing sitting time may be particularly important for people who are NWB post-fracture.

Early versus delayed weight bearing after intramedullary nailing for tibial shaft fracture: A multicenter, propensity score-matched study, the TRON study.

The purpose of this multicenter study was to assess the differences in the rates of implant failure and bone union by X-ray examination, and walking ability between an early weight-bearing group (EWB) and a non-weight-bearing group (NWB) following treatment with intramedullary nailing (IMN) for tibial shaft fractures with a propensity score-matching method. We collected data from 336 patients with tibia fractures that were treated surgically. We excluded patients lost to follow-up and polytrauma patients. Finally, 263 patients were included who were divided into two groups, the early weight-bearing (EWB) group, in which partial weight-bearing walking within four weeks was encouraged, and a non-weight-bearing (NWB) group, in which no weight bearing was allowed for more than four weeks. To adjust for baseline differences between groups, a propensity score algorithm was used to match the EWB group with the NWB group in a 1:1 ratio of 75 cases each. After matching, we compared the rate of implant failure, the rate of bone union at six months and one year after surgery, and walking ability at the last follow-up between the two groups. Implant failure occurred in 0 of 75 patients in the EWB group vs. 1 of 75 in the NWB group (P=1.0). Delayed bone union at six months occurred in 20 of 75 (26%) vs. 13 of 75 (17%) patients, and that at one year occurred in 5 of 75 (6.7%) vs. 3 of 75 (4%) patients. The median New Mobility Score was 9 (4-9) vs. 9 (0-9) points. There were no statistically significant differences in the rate of implant failure, the rates of the bone union at six months and one year after surgery, and walking ability between the EWB group and NWB group. We suggest that instruction in early weight-bearing after IMN nailing for tibial shaft fracture may not be harmful.

Immediate Weight Bearing and Range of Motion After Internal Fixation of Unstable Ankle Fractures: A Retrospective Controlled Study

Category:Ankle; TraumaIntroduction/Purpose:Ankle fractures are the third most common adult fractures. Further, they are the second most common fracture type to require inpatient admission, behind only hip fractures, despite occurring in a population on average nearly 30 years younger. There is evidence that early or immediate weight bearing and range of motion may be safe following ankle fracture fixation, but existing studies are small and largely exclude patients with syndesmotic or posterior malleolar fixation. We therefore studied the safety of immediate weight bearing as tolerated (IWBAT) and immediate range of motion (IROM) following open reduction internal fixation (ORIF) of unstable ankle fractures in a diverse cohort and attempted to identify risk factors for complications.Methods:We performed a retrospective case-control study. Out of 268 patients who underwent primary ORIF of an unstable ankle fracture from 2013-18, we identified 133 (49.6%) who were IWBAT and IROM. The treating surgeon excluded patients from IWBAT if they had an ipsilateral leg injury requiring non-weight bearing, a large displaced posterior malleolus fragment, or Maisonneuve injury with fracture of the proximal fibula. We used propensity-score matching to identify 172 controls who were non-weight bearing (NWB) and no range of motion for 6 weeks post-op. We reviewed medical records and radiographs for demographic, injury and treatment characteristics. Our primary outcome was complications. We compared demographics, injury characteristics, treatment episode, and complications between the IWBAT and NWB groups and performed within group analysis to identify risk factors for complications. A p-value <0.05 was considered significant.Results:The groups did not differ significantly in age, BMI, Charleston Comorbidity Index (CCI), smoking status, diabetes status, malleoli involved, percentages undergoing medial malleolus (60.9% IWBAT vs. 51.7% NWB, p=0.11), posterior malleolus (24.1% IWBAT, 26.7% NWB, p=0.59), or syndesmosis fixation (41.4% IWBAT, 42.4% NWB, p=0.85). There was no significant difference in total complications (9.8% IWBAT vs. 12.8% NWB, p=0.41), nonoperative complications (6.8% IWBAT vs. 8.7% NWB, p=0.53), or operative complications (3.8% IWBAT vs. 4.1% NWB, p=0.89). We did not identify any factors associated with increased complication risk, including posterior malleolus or syndesmosis fixation, diabetes, age, CCI or pre-injury assisted ambulation.Conclusion:IWBAT and IROM may be safe following ankle fracture ORIF in a broader patient population than previously believed. We did not identify specific risk factors for post-operative complications. Further study on patient selection may allow for more extensive use of this protocol to reduce the morbidity associated with unstable ankle fractures.

What type of exercise is most effective for people with knee osteoarthritis and co-morbid obesity?: The TARGET randomized controlled trial

Different exercise types may yield different outcomes in osteoarthritis (OA) subgroups. The objective was to directly compare effectiveness of two exercise programs for people with medial knee OA and co-morbid obesity. We performed a participant- and assessor-blinded randomized controlled trial. 128 people ≥50 years with medial knee OA and body mass index ≥30kg/m2 were recruited from the community. Interventions were home-based non-weight bearing (NWB) quadriceps strengthening or weight bearing (WB) functional exercise for 12 weeks. Primary outcomes were change in overall knee pain (numeric rating scale, range 0-10) and difficulty with physical function (Western Ontario and McMaster Universities Osteoarthritis Index, 0-68) over 12 weeks. Secondary outcomes included other pain measures, physical function, quality-of-life, global changes, physical performance, and lower-limb muscle strength. 123 (96%) participants were retained. There was no evidence of a between-group difference in change in pain (mean difference 0.73 units (95% confidence intervals (0.05,1.50)) or function (2.80 units (-1.17,6.76)), with both groups reporting improvements. For secondary outcomes, the WB group had greater improvement in quality-of-life (-0.043 units (-0.085,-0.001)) and more participants reporting global improvement (overall: relative risk 1.40 (0.98,2.01); pain 1.47 (0.97,2.24); function 1.43 (1.04,1.98). Although adverse events were minor, more NWB group participants reported ≥1 adverse event (26/66 (39%) vs 14/62 (23%), p=0.04). Both exercise types similarly improved primary outcomes of pain and function and can be recommended for people with knee OA and obesity. WB exercise may be preferred given fewer adverse events and potential additional benefits on some secondary outcomes. Prospectively registered (Australian New Zealand Clinical Trials Registry #12617001013358, 14/7/2017).

Postoperative Weightbearing Protocols After Arthroscopic Surgery for Femoroacetabular Impingement Does Not Affect Patient Outcome: A Comparative Study With Minimum 2-Year Follow-up

To evaluate the effects of immediate postoperative weightbearing protocols after hip arthroscopy for femoroacetabular impingement (FAI) with minimum 2-year follow-up, as measured by patient-reported outcome measures and satisfaction rates. Between January 2011 and June 2016, patients undergoing hip arthroscopy for FAI and labral tears were reviewed. Exclusion criteria was previous hip pathology or arthroscopy, active Workers' Compensation claims, and concomitant pathologies impeding weightbearing. Patients who were operated on before September 2013 were treated with 3weeks of postoperative non-weightbearing (NWB), with weightbearing as tolerated (WBAT) thereafter. From October 2013, patients were allowed immediate postoperative WBAT. A total of 351 hip arthroscopic surgeries were performed; 133 of these patients met the inclusion criteria. Of the 133 included patients, 69 were in the NWB group and 64 were in the WBAT group. No differences were found in terms of sex (P= .603) or age (P= .241). No differences were found in postoperative scores (the Modified Harris Hip Score was 84.5 [range 79-89] for NWB vs 86.7 [78-89] for WBAT [P= .0.523], and the Hip Outcome Score was 83.1 [78-88] vs 88.4 [80-90], respectively; P= .130). Subjective rates of improvement, satisfaction score and the will to undergo surgery again did not differ between the groups (P= .674, P= .882, P= .730). The rate of subjects who met or exceeded the MCID in the NWB and WBAT groups was 82.6% and 81.2% for the Modified Harris Hip Score (P= .838) and 79.7% and 82.8% for the Hip Outcome Score (P=.647). There were no reported complications. Limitations include the possibility of the study being underpowered. After a 2-year minimum follow-up, patient-reported outcome measures and satisfactory rates with immediate weightbearing after hip arthroscopy for isolated FAI syndrome and labral tears do not differ significantly from results after strict NWB rehabilitation protocols. Revising weightbearing restrictions may allow for a more comfortable rehabilitation process after arthroscopic hip surgery for FAI and labral repair. Level 3 - case-control study.

Partial Controlled Early Postoperative Weightbearing Versus Nonweightbearing After Reconstruction of the Fibular (Lateral) Collateral Ligament: A Randomized Controlled Trial and Equivalence Analysis

Background: While early weightbearing protocols have been advocated after anterior cruciate ligament (ACL) reconstruction, early weightbearing after fibular (lateral) collateral ligament reconstruction has not been well defined. Purpose: (1) To determine if early partial controlled weightbearing after fibular collateral ligament (FCL) reconstruction resulted in an objective difference in laxity on varus stress radiographs at postoperative 6 months as compared with nonweightbearing, and (2) to determine if there was a difference in pain, edema, range of motion, and subjective patient-reported outcomes between these groups at 3 time points. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients were prospectively enrolled from January 2014 to April 2017. Patients who underwent isolated FCL reconstruction or combined ACL and FCL reconstructions were included in this study. Patients were randomly assigned to either a control group (nonweightbearing for 6 weeks) or a treatment group (partial controlled weightbearing at 40% body weight with crutches for 6 weeks). Patient-related data, including knee pain, edema, and range of motion, were collected for all patients at postoperative day 1, 6 weeks, and 6 months. Subjective outcomes were collected preoperatively and at 6 months postoperatively. The primary objective endpoint was varus stability, evaluated by bilateral varus stress radiographs obtained preoperatively and at 6 months postoperatively. Results: Thirty-nine patients were enrolled in the study, with 6-month follow-up obtained for 36 (92%). There was a significant improvement between the preoperative side-to-side difference (SSD) (2.4 ± 1.0) and postoperative SSD (0.2 ± 1.0) for lateral compartment laxity on varus stress radiographs among all patients (P < .001). Clinical and statistical equivalence was found between groups in terms of SSD on varus stress radiographs (P < .001). The SSD in knee edema was significantly lower in the partial early weightbearing group (beta = −0.6 cm, P = .001), but there were no significant group differences in knee pain, flexion, or extension. All patients demonstrated significant improvements in subjective outcome scores between the preoperative and 6-month postoperative conditions (P < .001 for every score measured). Conclusion: Clinical and statistical equivalence was found at postoperative 6 months between the early partial weightbearing and nonweightbearing groups among patients undergoing either an isolated FCL reconstruction or a combined ACL and FCL reconstruction. There were no significant differences observed between the groups regarding knee stability, pain, swelling, range of motion, or subjective outcomes. Given these findings, the authors recommend early partial weightbearing after isolated FCL reconstruction or combined ACL and FCL reconstruction.

Reverse Shoulder Arthroplasty in the Weight-Bearing Versus Non-Weight-Bearing Shoulder: Mid-term Outcomes With Minimum 5-Year Follow-up.

This retrospective review evaluated the mid-term outcomes of cemented reverse shoulder arthroplasty in patients who use the shoulder for weight bearing (WB) vs non-weight-bearing (NWB) patients. Twenty-five shoulders of 21 patients who used their upper extremity for WB (WB group) were treated with cemented reverse shoulder arthroplasty and followed for a minimum of 5 years postoperatively (average, 73 months). Seventy-five consecutive shoulders of 72 patients who were NWB (NWB group) were treated and matched for duration of follow-up (average, 72 months) to serve as a control group. Patients were followed clinically and radiographically. There were no statistically significant differences between the WB group and the NWB group regarding final outcome scores or range of motion. Patient satisfaction was similar between the WB group (92%) and the NWB group (94%). The scapular notching rate was 20% in the WB group compared with 5% in the NWB group (P=.041). Humeral loosening occurred in 12% of the WB group vs 0% of the NWB group (P=.014). The complication rate was higher in the WB group than in the NWB group (12% vs 4%). The WB group and the NWB group had similar outcome scores, range of motion improvements, and patient satisfaction after reverse shoulder arthroplasty. At mid-term follow-up, the WB group had a higher scapular notching rate, humeral loosening rate, and complication rate than the NWB group. [Orthopedics. 2018; 41(3):e328-e333.].

Immediate weight-bearing as tolerated has improved outcomes compared to non–weight-bearing after surgical stabilisation of midshaft clavicle fractures in polytrauma patients

BackgroundClavicle fractures are common injuries in the polytrauma population and frequently limit early mobilisation. This study evaluates the effect of immediate crutch weight-bearing (WB) in polytrauma patients after surgical stabilisation of a displaced midshaft clavicle fracture. MethodsA retrospective review identified 26 polytrauma patients with operatively managed displaced midshaft clavicle fractures and a non–weight-bearing (NWB) lower extremity injury. Patients were allowed immediate WB after surgery or NWB. The primary outcome was total hospital length of stay. Statistical analysis was done using Mann–Whitney U test. ResultsThe WB group had decreased total hospital length of stay (10.4 vs. 17.0 days, p = 0.012) and improved physical therapy score (3.9 vs. 2.9, p = 0.054) and postoperative length of stay (6.8 vs. 12.7 days, p = 0.006) compared with the NWB group. ConclusionsOur data suggest that an immediate WB as tolerated protocol for polytrauma patients after surgical fixation of displaced clavicle fractures may decrease the overall length of stay.

L’appui modifie-t-il la consolidation après enclouage centro-médullaire des fractures diaphysaires du tibia

IntroductionThere is no consensus regarding postoperative weight-bearing (WB) assignment after treatment of tibial shaft fractures with an intramedullary nail. This study aims to determine if the postoperative WB assignment after tibia intramedullary nail placement alters healing. MethodsClosed AO type 42A fractures treated with a reamed statically-locked intramedullary nail over a 10-year period were retrospectively reviewed from injury at 2, 3, 6, 9, and 12 months intervals until union or revision. Patients were categorized according to postoperative weight-bearing assignment: weight-bearing-as-tolerated (WBAT) or non-weight-bearing (NWB). Patients with additional diagnoses that confound routine fracture healing were excluded. Postoperative radiographic union scores for tibial fractures (RUST), coronal/sagittal angulations, and length were compared between different weight-bearing groups. Union was defined as a RUST≥10 at a painless fracture site. ResultsA total of 83 patients achieved union (32 WBAT, 51 NWB). Both WB groups had similar preoperative demographics. Average age was 37±13 years and follow-up averaged 1.3±0.2 years. There were no significant differences in average time to radiographic union between NWB versus WBAT groups (5.5 vs. 6.1 months, respectively; P=0.208) nor radiographic healing at 2, 3, and 6-month intervals (P=0.631). There were two nonunions and one fracture shortened in the NWB group. There were no reoperations for symptomatic or broken hardware in either cohort. ConclusionImmediate WBAT after statically-locked intramedullary nail placement in simple tibial shaft fractures does not alter the time until or course of radiographic union. Level of evidenceIV.

Does weight-bearing assignment after intramedullary nail placement alter healing of tibial shaft fractures?

IntroductionThere is no consensus regarding postoperative weight-bearing (WB) assignment after treatment of tibial shaft fractures with an intramedullary nail. This study aims to determine if the postoperative WB assignment after tibia intramedullary nail placement alters healing. MethodsClosed AO type 42A fractures treated with a reamed statically-locked intramedullary nail over a 10-year period were retrospectively reviewed from injury at 2, 3, 6, 9 and 12 month intervals until union or revision. Patients were categorized according to postoperative weight-bearing assignment: weight-bearing-as-tolerated (WBAT) or non-weight-bearing (NWB). Patients with additional diagnoses that confound routine fracture healing were excluded. Postoperative radiographic union scores for tibial fractures (RUST), coronal/sagittal angulations, and length were compared between different weight-bearing groups. Union was defined as a RUST≥10 at a painless fracture site. ResultsA total of 83 patients achieved union (32 WBAT, 51 NWB). Both WB groups had similar preoperative demographics. Average age was 37±13 years and follow-up averaged 1.3±0.2 years. There were no significant differences in average time to radiographic union between NWB versus WBAT groups (5.5 vs. 6.1 months, respectively; P=0.208) nor radiographic healing at 2, 3, and 6-month intervals (P=0.631). There were two nonunions and one fracture shortened in the NWB group. There were no reoperations for symptomatic or broken hardware in either cohort. ConclusionImmediate WBAT after statically-locked intramedullary nail placement in simple tibial shaft fractures does not alter the time until or course of radiographic union. Level of evidenceIV.

Nonoperative, Dynamic Treatment of Acute Achilles Tendon Rupture: Influence of Early Weightbearing on Biomechanical Properties of the Plantar Flexor Muscle–Tendon Complex—A Blinded, Randomized, Controlled Trial

Acute Achilles tendon rupture alters the biomechanical properties of the plantar flexor muscle–tendon complex that can affect functional performance and the risk of repeat injury. The purpose of the present study was to compare the biomechanical properties of the plantar flexor muscle–tendon complex in patients randomized to early weightbearing or non-weightbearing in the nonoperative treatment of Achilles tendon rupture. A total of 60 patients were randomized to full weightbearing from day 1 of treatment or non-weightbearing for 6 weeks. After 6 and 12 months, the peak passive torque at 20° dorsiflexion, the stiffness during slow stretching, and the maximal strength were measured in both limbs. The stiffness of the plantar flexor muscle–tendon complex in the terminal part of dorsiflexion was significantly increased (p = .024) in the non-weightbearing group at 12 months. The peak passive torque was significantly lower for the affected limb at 6 months (91%; p = .01), and the stiffness was significantly lower for the affected limb during the early part of dorsiflexion at 6 (67%; p < .001) and 12 (77%; p < .001) months. In conclusion, an increased stiffness of the plantar flexor muscle–tendon complex in the terminal part of dorsiflexion was found in the non-weightbearing group. The altered stiffness and strength in the affected limb could affect the coordination of gait and running.