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Introduction: Early Weight-bearing Constructs in the Lower Extremity

Early weight-bearing constructs in the lower extremity

Bogdan, Yelena MD; Sen, Milan MD

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doi: 10.1097/OI9.0000000000000182
  • Open

In early 2020, in the editorial “A call to arms: it's time to bear weight,” Trompeter[1] stated: “as we travel down the limb, we see an increased reluctance on the part of the treating surgeon to allow the patient to bear weight postoperatively.” While early weight-bearing in postoperative hip fracture constructs is well established, fractures distal to the hip are less likely to be allowed full mobilization, even in the frail elderly. A steadily increasing stream of literature, from the ankle up, shows potential advantages in immediate weight-bearing in the lower extremity with few, if any, ill effects.[2–5] While the literature itself is not always Level 1 or methodologically robust, surgeons must be aware of this option as they deal with an onslaught of fragility fractures in the lower extremity.[6]

In the last 10 years of Orthopaedic Trauma Association material, early weight-bearing studies have been published, but the topic has never had its own focus in a supplement. We believe it is important for the Orthopaedic Trauma Association to give this subject focused traction, so that community and other surgeons feel comfortable initiating these changes after learning from the experiences of master surgeons who are early adopters and pioneers of new constructs and techniques in this arena. Early mobility and weight-bearing is extremely important for decreasing medical complications, morbidity, and mortality in our patients, particularly in the elderly.

The aims of this supplement include a combination of thorough literature reviews, case series replete with examples of constructs such as the nail-plate for the distal femur, and technique tips to increase the comfort of the treating surgeon in allowing early weight-bearing. Special attention is paid to the distal femur, as a fragility fracture with similar morbidity as hip fractures, but the supplement also includes the proximal tibia/plateau, distal tibia, and ankle.

References

1. Trompeter A. A call to arms: it's time to bear weight!. Bone Joint J 2020; 102-B:403–406.
2. Simanski CJ, Maegele MG, Lefering R, et al. Functional treatment and early weightbearing after an ankle fracture: a prospective study. J Orthop Trauma 2006; 20:108–114.
3. Lieder CM, Gaski GE, Virkus WW, et al. Is Immediate Weight-Bearing Safe Following Single Implant Fixation of Elderly Distal Femur Fractures? J Orthop Trauma 2021; 35:49–55.
4. Haak KT, Palm H, Holck K, et al. Immediate weight-bearing after osteosynthesis of proximal tibial fractures may be allowed. Dan Med J 2012; 59:A4515.
5. Yoon RS, Bible J, Marcus MS, et al. Outcomes following combined intramedullary nail and plate fixation for complex tibia fractures: a multicentre study. Injury 2015; 46:1097–1101.
6. Donohoe E, Roberts HJ, Miclau T, et al. Management of lower extremity fractures in the elderly: a focus on post-operative rehabilitation. Injury 2020; 51 (Suppl 2):S118–S122.
Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association.