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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 5/2022

Open Access 03-03-2022 | Review Article

Outcomes of early versus delayed weight-bearing with intramedullary nailing of tibial shaft fractures: a systematic review and meta-analysis

Authors: Ameya Bhanushali, Joshua G. Kovoor, Brandon Stretton, James T. Kieu, Rebecca A. Bright, Joseph N. Hewitt, Christopher D. Ovenden, Aashray K. Gupta, Mohamed Z. Afzal, Suzanne Edwards, Ruurd L. Jaarsma, Christy Graff

Published in: European Journal of Trauma and Emergency Surgery | Issue 5/2022

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Abstract

Purpose

Early weight bearing (EWB) is often recommended after intramedullary nailing of tibial shaft fractures, however, the risks and benefits have not been critically evaluated in a systematic review or meta-analysis. Therefore, the aims of this study were to perform a systematic review and meta-analysis comparing EWB and delayed weight-bearing (DWB) after intramedullary nailing of tibial shaft fractures and assess the relationship between weight-bearing, fracture union and healing.

Method

This review included studies comparing the effects of EWB, defined as weight-bearing before 6 weeks, and DWB on fracture union and healing. PubMed, Embase, CINAHL, and the Cochrane Library were searched from inception to 9 May 2021. Risk of bias was assessed using the Down’s and Black Checklist and Cochrane Risk of Bias Tool 2.0. Data were synthesised in a meta-analysis, as well as narrative and tabular synthesis.

Results

Eight studies were included for data extraction and meta-analysis. The analysis produced mixed results and found a significant decrease in mean union time (−2.41 weeks, 95% confidence interval: −4.77, −0.05) with EWB and a significant Odd’s Ratio (OR) for complications with DWB (OR: 2.93, 95% CI: 1.40, 6.16). There was no significant difference in rates of delayed union, non-union, re-operation and malunion.

Conclusion

The included studies were of moderate risk of bias and demonstrated shorter union time and fewer complications with EWB. However, current evidence is minimal and has significant limitations. The role of EWB in high-risk patients is yet to be examined. Further well-designed, randomised studies are required on the topic.
Appendix
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Metadata
Title
Outcomes of early versus delayed weight-bearing with intramedullary nailing of tibial shaft fractures: a systematic review and meta-analysis
Authors
Ameya Bhanushali
Joshua G. Kovoor
Brandon Stretton
James T. Kieu
Rebecca A. Bright
Joseph N. Hewitt
Christopher D. Ovenden
Aashray K. Gupta
Mohamed Z. Afzal
Suzanne Edwards
Ruurd L. Jaarsma
Christy Graff
Publication date
03-03-2022
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 5/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-022-01919-w

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