Abstract
Introduction
Plate fixation for distal femoral fractures is a commonly used method of fracture stabilisation. Many orthopaedic surgeons traditionally do not allow their patients to weight bear for the first 6 weeks after surgery, fearing of loss of fracture reduction and metalwork failure. The aim of this study is to investigate whether the post-operative weight bearing status after plate fixation influences the outcome in terms of loss of reduction and metalwork failure.
Materials & Methods
A retrospective data collection from all patients who treated in our hospital surgically for distal femoral fractures, from January 2015 until June 2017. Inclusion criteria were the operative treatment of these fractures with plate fixation. Patients who were treated with retrograde nail, primary total knee replacement or screw fixation were excluded from the study. Patient, injury and surgery demographic data was collected. The immediate post-operative weight bearing status of these patients was noted. Weight bearing status was divided into two groups – Group 1 (Non and touch weight bear – the non-weight bearing group) and Group 2 (Weight bear as tolerated / Full weight bear – the weight bearing group). Radiological data about fracture displacement or metalwork failure was collected at the six weeks and three months follow up after the operation, using a standardised measurement for displacement performed independently by two authors (EI, TA).
Results
Of 70 patients, a total of 51 fractures treated with plate fixation were included to the study. The mean age of the cohort was 64.3 ±20.7 years with the majority of the patients being female (63%). Most of the patients (40%) had a complete articular distal femoral fracture, AO Type 33C. Thirty-nine patients (76%) were treated with one lateral distal femoral plate. The total number of the patients in group 1 was 32 (68%); with 17 patients (32%) in group 2. The weight bearing status did not correlate with the fracture type or the fixation type (p>0.05). None of the 6 weeks follow up radiographs revealed fracture displacement in both study groups. Four of the patients from the non-weight bearing group had >1mm displacement at the 3 months' follow-up radiographs. Fisher's exact test revealed no statistically significant difference between the two study groups in both follow-up time points (p=0.55). Two of the patients in the non-weight bearing group had their plate broken at the 3 months follow up and required revision fixation.
Conclusion
By reviewing the outcomes in terms of fracture displacement and metalwork failure following plate fixation of distal femoral fractures, early weight bearing of these patients do not jeopardise the outcome of the operation.
