Temporary Partial Weight-Bearing Restriction in Elderly Patients Treated With a Plate Fixation After a Distal Femur Fracture had a Negative Long-Term Impact on Gait Recovery
(2023) In Geriatric Orthopaedic Surgery and Rehabilitation 14.- Abstract
Background: Restricted weight-bearing is still used after lower extremity fracture surgery in elderly patients. The long-term effect on gait recovery in elderly patients with distal femur fractures (DFF) and their ability to comply with the restrictive weight-bearing regime is unknown. This study aimed to investigate the effect of restricted postoperative weight-bearing on gait recovery (actual weight-bearing and cadence) during a 1-year follow-up. Methods: This study evaluated secondary outcomes from a randomized controlled trial (32 patients ≥65 years, with a traumatic DFF). Internal fixation was achieved using an anatomical lateral plate. Patients were allocated to either immediate full weight-bearing (FWB) or partial weight-bearing... (More)
Background: Restricted weight-bearing is still used after lower extremity fracture surgery in elderly patients. The long-term effect on gait recovery in elderly patients with distal femur fractures (DFF) and their ability to comply with the restrictive weight-bearing regime is unknown. This study aimed to investigate the effect of restricted postoperative weight-bearing on gait recovery (actual weight-bearing and cadence) during a 1-year follow-up. Methods: This study evaluated secondary outcomes from a randomized controlled trial (32 patients ≥65 years, with a traumatic DFF). Internal fixation was achieved using an anatomical lateral plate. Patients were allocated to either immediate full weight-bearing (FWB) or partial weight-bearing (PWB) (30% of body weight) for 8 weeks. Pressure-sensitive sensors (F-scan™ system, Tekscan, Massachusetts, USA) were used to measure weight-bearing and cadence postoperatively and at 8-, 16-, and 52-week follow-ups. Twenty-six patients with at least 1 measurement were included. Results: There was a statistically significant difference in actual weight-bearing between the PWB and FWB groups postoperatively of 32.3% (95% confidence interval CI, −50.0; −13.0, P <.001) and at the 8-week follow-up of 36.8% (95% CI −61.0; −18.0, P =.01), but not at later follow-ups. The PWB group presented a consistently lower cadence compared to the FWB group, which was statistically significant at the 16-week follow-up with 9.0 steps/min (95% CI -16.2; −1.1, P =.047) and 52-week follow-up with 9.3 steps/min (95% CI −18.0; −3.9, P =.009). Conclusions: Restricting postoperative weight-bearing in elderly patients with a DFF had a significant effect on postoperative weight-bearing. The effect lingered with a delayed return to FWB and persistent significantly lower cadence in the PWB group. These findings suggest that even temporary weight-bearing restrictions most likely have negative long-term effects on gait function at 1 year and, therefore, cannot be recommended.
(Less)
- author
- Paulsson, Martin ; Ekholm, Carl ; Rolfson, Ola ; Geijer, Mats LU and Tranberg, Roy
- organization
- publishing date
- 2023-01-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- femoral fracture, fracture fixation, function recovery, gait analysis, internal, orthopaedic surgical procedure, weight-bearing
- in
- Geriatric Orthopaedic Surgery and Rehabilitation
- volume
- 14
- publisher
- SAGE Publications
- external identifiers
-
- pmid:37842343
- scopus:85174168248
- ISSN
- 2151-4585
- DOI
- 10.1177/21514593231184945
- language
- English
- LU publication?
- yes
- id
- e9d17c54-335c-4f09-bc50-05d6f440a47e
- date added to LUP
- 2023-12-14 15:18:15
- date last changed
- 2024-04-13 07:23:15
@article{e9d17c54-335c-4f09-bc50-05d6f440a47e,
abstract = {{<p>Background: Restricted weight-bearing is still used after lower extremity fracture surgery in elderly patients. The long-term effect on gait recovery in elderly patients with distal femur fractures (DFF) and their ability to comply with the restrictive weight-bearing regime is unknown. This study aimed to investigate the effect of restricted postoperative weight-bearing on gait recovery (actual weight-bearing and cadence) during a 1-year follow-up. Methods: This study evaluated secondary outcomes from a randomized controlled trial (32 patients ≥65 years, with a traumatic DFF). Internal fixation was achieved using an anatomical lateral plate. Patients were allocated to either immediate full weight-bearing (FWB) or partial weight-bearing (PWB) (30% of body weight) for 8 weeks. Pressure-sensitive sensors (F-scan™ system, Tekscan, Massachusetts, USA) were used to measure weight-bearing and cadence postoperatively and at 8-, 16-, and 52-week follow-ups. Twenty-six patients with at least 1 measurement were included. Results: There was a statistically significant difference in actual weight-bearing between the PWB and FWB groups postoperatively of 32.3% (95% confidence interval CI, −50.0; −13.0, P <.001) and at the 8-week follow-up of 36.8% (95% CI −61.0; −18.0, P =.01), but not at later follow-ups. The PWB group presented a consistently lower cadence compared to the FWB group, which was statistically significant at the 16-week follow-up with 9.0 steps/min (95% CI -16.2; −1.1, P =.047) and 52-week follow-up with 9.3 steps/min (95% CI −18.0; −3.9, P =.009). Conclusions: Restricting postoperative weight-bearing in elderly patients with a DFF had a significant effect on postoperative weight-bearing. The effect lingered with a delayed return to FWB and persistent significantly lower cadence in the PWB group. These findings suggest that even temporary weight-bearing restrictions most likely have negative long-term effects on gait function at 1 year and, therefore, cannot be recommended.</p>}},
author = {{Paulsson, Martin and Ekholm, Carl and Rolfson, Ola and Geijer, Mats and Tranberg, Roy}},
issn = {{2151-4585}},
keywords = {{femoral fracture; fracture fixation; function recovery; gait analysis; internal; orthopaedic surgical procedure; weight-bearing}},
language = {{eng}},
month = {{01}},
publisher = {{SAGE Publications}},
series = {{Geriatric Orthopaedic Surgery and Rehabilitation}},
title = {{Temporary Partial Weight-Bearing Restriction in Elderly Patients Treated With a Plate Fixation After a Distal Femur Fracture had a Negative Long-Term Impact on Gait Recovery}},
url = {{http://dx.doi.org/10.1177/21514593231184945}},
doi = {{10.1177/21514593231184945}},
volume = {{14}},
year = {{2023}},
}