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04-05-2024 | Original Article

Is immediate weight bearing safe for subtrochanteric femur fractures in elderly patients treated by cephalomedullary nailing? A multicentric study in one hundred eighty-two patients

Authors: Iñigo SanJosé-Pardo, José Antonio Valle-Cruz, Susana Donadeu-Sánchez, Héctor J. Aguado, Sergio País-Ortega, Javier Montoya-Adarraga, Ángel Díez-Rodríguez, Juan Antonio Alonso Del Olmo, Juan Mingo-Robinet

Published in: European Journal of Orthopaedic Surgery & Traumatology

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Abstract

Purpose

Biomechanical superiority of intramedullary nails over extramedullary implants has been proved for subtrochanteric fractures. Nevertheless, postoperative management of these patients has not changed, with high rates of protected weight-bearing after intramedullary nailing.
The purpose of this study is to determine the mechanical complications of immediate postoperative full weigh-bearing for subtrochanteric femur fractures in elderly patients treated with a cephalomedullary nail.

Methods

We performed a retrospective case series study from patients treated with a cephalomedullary nail for subtrochanteric fractures (AO/OTA 31A.3 and 32A-32C) over a nine-year period.
Patients in the immediate full weight-bearing (IFWB) group received orders for immediate full weight bear as tolerated on postoperative 48 h. Patients in the non- or limited- weight-bearing (NLWB) group received orders not to full weight bear in the immediate postoperative.

Results

There were five (2.7%) cases of implant failure including four cutouts and one nail breakage that needed a reoperation. Of them, one (2.2%) followed the NLWB protocol and four (2.9%) followed the IFWB protocol.
Mean length of stay was 7.9 days (median 8, range 3–21) in the NLWB group and 10.7 days (median 8, range 2–60) in the IWBAT group. The NLWB group observed a 2.8-day shorter postoperative length of stay when compared to the IFWB, but the median remained equal.

Conclusion

This study suggests that geriatric patients with subtrochanteric fractures treated by intramedullary nailing and in which a good fracture reduction was achieved, may be able to tolerate immediate postoperative full weight-bearing, not increasing reoperation rates due to implant failure.
Literature
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Metadata
Title
Is immediate weight bearing safe for subtrochanteric femur fractures in elderly patients treated by cephalomedullary nailing? A multicentric study in one hundred eighty-two patients
Authors
Iñigo SanJosé-Pardo
José Antonio Valle-Cruz
Susana Donadeu-Sánchez
Héctor J. Aguado
Sergio País-Ortega
Javier Montoya-Adarraga
Ángel Díez-Rodríguez
Juan Antonio Alonso Del Olmo
Juan Mingo-Robinet
Publication date
04-05-2024
Publisher
Springer Paris
Published in
European Journal of Orthopaedic Surgery & Traumatology
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-024-03897-8