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Locked plating, immediate weight-bearing seen as safe for periprosthetic distal femur fractures
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Investigators of this study found less-invasive locked plate fixation and unrestricted weight-bearing immediately afterward was safe and practical for the treatment of patients with periprosthetic distal femur fractures.
Researchers retrospectively observed 52 patients with a total of 54 periprosthetic distal femur fractures treated with locked plate fixation. A standardized institutional protocol was used for all patients which included admission to a hospitalist service from the emergency department, surgery within 24 hours of admission, standardized thromboembolic prophylaxis before surgery, minimally invasive locked plating and postoperative weight-bearing. There was also a standardized follow-up for 1 year.
The rate of postoperative complications was the primary outcome. Secondary outcomes included time to surgery, intraoperative blood loss, duration of surgery, length of hospital stay, time to full weight-bearing and radiographic healing. Follow-ups were performed at 2 weeks, 8 weeks, 14 weeks to 16 weeks, 6 months and 1 year.
Findings showed three implants failed. In addition, there was one nonunion and two patients had symptomatic malunion. Investigators noted patellar component instability correlated with valgus alignment in one patient and this caused knee pain. Although, there was consistent anticoagulation, 10 thromboembolic complications occurred.
Within 12 months of injury, two patients died. At the 1-year follow-up, 38 patients returned to their preinjury ambulation status. ‒ by Monica Jaramillo
Disclosures: Smith reports no relevant financial disclosures. Please see the full study for a list of all other author’s relevant financial disclosures.
Perspective
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Morten Schultz Larsen, MD
Studies investigating postoperative care are not very common despite the well-established importance of mobilizing patients fast, especially elderly patients. So here is a longtime wanted study which tell us it is safe to allow immediate weight bearing after locked plate fixation of periprosthetic knee fractures — or does it? Can we know that the three implant failures, malunions and nonunions were not caused by immediate weight bearing or that 10 thromboembolic complications perhaps would have been 20 if weight bearing were not allowed? To answer these questions, we need some kind of control group, which is agonizingly missing in this study.
I believe the authors got it right, that immediate weight bearing is safe and a benefit for the patients, but this study does not prove it.
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