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Immediate weight bearing as tolerated (WBAT) correlates with a decreased length of stay post intramedullary fixation for subtrochanteric fractures: a multicenter retrospective cohort study

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Abstract

Background

Subtrochanteric femur fractures associate with a relatively high complication rate and are traditionally treated operatively with a period of limited weight bearing. Transitioning from extramedullary to intramedullary implants, there are increasing biomechanical and clinical data to support early weight bearing. This multicenter retrospective study examines the effect of postoperative weight bearing as tolerated (WBAT) for subtrochanteric femur fractures. We hypothesize that WBAT will result in a decreased length of stay (LOS) without increasing the incidence of re-operation.

Methods

This study assesses total LOS and postoperative LOS after intramedullary fixation for subtrochanteric fractures between postoperative weight bearing protocols across 6 level I trauma centers (n = 441). Analysis techniques consisted of multivariable linear regression and nonparametric comparative tests. Additional subanalyses were performed, targeting mechanism of injury (MOI), Winquist–Hansen fracture comminution, 20-year age strata, and injury severity score (ISS).

Results

Total LOS was shorter in WBAT protocol within the overall sample (7.4 vs 9.7 days; p < 0.01). Rates of re-operation were similar between the two groups (10.6% vs 10.5%; p = 0.99). Stratified analysis identified patients between ages 41–80, WH comminution 2–3, high MOI, and ISS between 6–15 and 21–25 to demonstrate a significant reduction in LOS as a response to WBAT.

Conclusion

An immediate postoperative weight bearing as tolerated protocol in patients with subtrochanteric fractures reduced length of hospital stay with no significant difference in reoperation and complication rates. If no contraindication exists, immediate weight bearing as tolerated should be considered for patients with subtrochanteric femur fractures treated with statically locked intramedullary nails.

Level of evidence

Therapeutic Level III.

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Funding

No funding was supplied for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA

    Brian P. Cunningham & Breanna Blaschke

  2. TRIA Orthopaedics, Bloomington, MN, USA

    Brian P. Cunningham & Breanna Blaschke

  3. Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA

    Brian P. Cunningham, Harsh R. Parikh & Austin Heare

  4. Florida Orthopaedic Institute, Tampa, FL, USA

    Ashley Ali

  5. Department of Orthopaedic Surgery, University of Miami Health System, Miami, FL, USA

    Austin Heare

  6. Department of Orthopaedics, Loma Linda University Medical Center, Loma Linda, CA, USA

    Saif Zaman & Hrayr Basmajian

  7. Department of Orthopaedics, R Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MA, USA

    Ryan Montalvo & Robert V. O’Toole

  8. Department of Orthopaedic Surgery, University of Washington School of Medicine, Seattle, WA, USA

    Bradley Reahl & John Kark

  9. Department of Orthopaedic Surgery, University of South Florida College of Medicine, Tampa, FL, USA

    Giuliana Rotuno & Mark Bender

  10. Department of Orthopaedic Trauma, Sonoran Orthopaedic Trauma Surgeons, Scottsdale, AZ, USA

    Brian Miller

  11. Clinical Outcomes and Data Engineering Technology, Phoenix, AZ, USA

    Ryan McLemore

  12. Department of Orthopaedic Surgery, San Francisco General Hospital, University of CA – San Francisco, San Francisco, CA, USA

    David W. Shearer

  13. Department of Orthopaedics, Vanderbilt University, Nashville, TN, USA

    William Obremskey

  14. Department of Orthopaedic Surgery, Harborview Medical Center, Seattle, WA, USA

    Claude Sagi

  15. Department of Orthopaedic Trauma, University of Cincinnati, Cincinnati, OH, USA

    Claude Sagi

  16. Saint Paul, MN, 55101, USA

    Brian P. Cunningham

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  1. Brian P. Cunningham
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Correspondence to Brian P. Cunningham.

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Cunningham, B.P., Ali, A., Parikh, H.R. et al. Immediate weight bearing as tolerated (WBAT) correlates with a decreased length of stay post intramedullary fixation for subtrochanteric fractures: a multicenter retrospective cohort study. Eur J Orthop Surg Traumatol 31, 235–243 (2021). https://doi.org/10.1007/s00590-020-02759-3

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  • DOI: https://doi.org/10.1007/s00590-020-02759-3

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