Weight-bearing Restrictions after Distal Femur Fractures - Review of Current Literature

Abstract

The incidence of distal femur fractures increases in the geriatric patient. The primary treatment goal in these fractures is early mobilisation to prevent secondary injuries associated with immobility. In light of the increasing spectrum of therapeutic options for postoperative fracture treatment, including double plating, nail-plate combination and distal femur replacement as postoperative treatments, weight-bearing recommendations are becoming increasingly important. The aim of this study was thus to analyse the weight-bearing recommendations and associated therapy results within the literature of the past 9 years and compare the recommendations to our own approach.

Keywords

distal femur fracture - postoperative weight-bearing - full weight-bearing - partial weight-bearing

Publication History

Received: 12 September 2021

Accepted after revision: 07 February 2022

Article published online:
21 March 2022

• Literatur

• 1 Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury 2006; 37: 691-697 DOI: 10.1016/j.injury.2006.04.130. (PMID: 16814787)
• 2 Court-Brown CM, Biant L, Bugler KE. et al. Changing epidemiology of adult fractures in Scotland. Scott Med J 2014; 59: 30-34 DOI: 10.1177/0036933013518148. (PMID: 24424464)
• 3 Elsoe R, Ceccotti AA, Larsen P. Population-based epidemiology and incidence of distal femur fractures. Int Orthop 2018; 42: 191-196 DOI: 10.1007/s00264-017-3665-1. (PMID: 29116356)
• 4 Ferris H, Brent L, Coughlan T. Early mobilisation reduces the risk of in-hospital mortality following hip fracture. Eur Geriatr Med 2020; 11: 527-533 DOI: 10.1007/s41999-020-00317-y. (PMID: 32297275)
• 5 Hake ME, Davis ME, Perdue AM. et al. Modern implant options for the treatment of distal femur fractures. J Am Acad Orthop Surg 2019; 27: e867-e875 DOI: 10.5435/JAAOS-D-17-00706. (PMID: 30939565)
• 6 Fontenot PB, Diaz M, Stoops K. et al. Supplementation of lateral locked plating for distal femur fractures: a biomechanical study. J Orthop Trauma 2019; 33: 642-648 DOI: 10.1097/BOT.0000000000001591. (PMID: 31335505)
• 7 Braun BJ, Veith NT, Rollmann M. et al. Weight-bearing recommendations after operative fracture treatment—fact or fiction? Gait results with and feasibility of a dynamic, continuous pedobarography insole. Int Orthop 2017; 41: 1507-1512 DOI: 10.1007/s00264-017-3481-7. (PMID: 28421239)
• 8 Kammerlander C, Pfeufer D, Lisitano LA. et al. Inability of older adult patients with hip fracture to maintain postoperative weight-bearing restrictions. J Bone Joint Surg Am 2018; 100: 936-941 DOI: 10.2106/JBJS.17.01222. (PMID: 29870444)
• 9 Pfeufer D, Zeller A, Mehaffey S. et al. Weight-bearing restrictions reduce postoperative mobility in elderly hip fracture patients. Arch Orthop Trauma Surg 2019; 139: 1253-1259 DOI: 10.1007/s00402-019-03193-9. (PMID: 31053870)
• 10 Unger EW, Histing T, Rollmann MF. et al. Development of a dynamic fall risk profile in elderly nursing home residents: A free field gait analysis based study. Arch Gerontol Geriatr 2021; 93: 104294 DOI: 10.1016/j.archger.2020.104294. (PMID: 33217640)
• 11 Keenan OJ, Ross LA, Magill M. et al. Immediate weight-bearing is safe following lateral locked plate fixation of periprosthetic distal femoral fractures. Knee Surg Relat Res 2021; 33: 19 DOI: 10.1186/s43019-021-00097-0. (PMID: 34172101)
• 12 Sidhu GAS, Singh H, Selhi H. et al. The Clinical and Radiological Evaluation of Far Cortex Locking Plate in Distal Femur Fractures. Cureus 2021; 13: e14289 DOI: 10.7759/cureus.14289. (PMID: 33968503)
• 13 Loosen A, Fritz Y, Dietrich M. Surgical treatment of distal femur fractures in geriatric patients. Geriatr Orthop Surg Rehabil 2019; 10: 2151459319860723 DOI: 10.1177/2151459319860723. (PMID: 31308992)
• 14 Consigliere P, Iliopoulos E, Ads T. et al. Early versus delayed weight bearing after surgical fixation of distal femur fractures: a non-randomized comparative study. Eur J Orthop Surg Traumatol 2019; 29: 1789-1794 DOI: 10.1007/s00590-019-02486-4. (PMID: 31267203)
• 15 Wang SH, Wu CC, Li WT. et al. Outcomes of distal femoral fractures treated with minimally invasive plate osteosynthesis versus open reduction internal fixation with combined locking plate and interfragmentary screws. Int J Surg 2019; 65: 107-112 DOI: 10.1016/j.ijsu.2019.03.019. (PMID: 30951872)
• 16 Mitchell PM, Lee AK, Collinge CA. et al. Early Comparative Outcomes of Carbon Fiber-Reinforced Polymer Plate in the Fixation of Distal Femur Fractures. J Orthop Trauma 2018; 32: 386-390 DOI: 10.1097/BOT.0000000000001223. (PMID: 29781944)
• 17 Poole WEC, Wilson DGG, Guthrie HC. et al. ‘Modern’distal femoral locking plates allow safe, early weight-bearing with a high rate of union and low rate of failure: five-year experience from a United Kingdom major trauma centre. Bone Joint J 2017; 99: 951-957 DOI: 10.1302/0301-620X.99B7.BJJ-2016-0585.R1. (PMID: 28663403)
• 18 Smith WR, Stoneback JW, Morgan SJ. et al. Is immediate weight bearing safe for periprosthetic distal femur fractures treated by locked plating? A feasibility study in 52 consecutive patients. Patient Saf Surg 2016; 10: 26 DOI: 10.1186/s13037-016-0114-9. (PMID: 27980675)
• 19 Smith JR, Halliday R, Aquilina AL. et al. Distal femoral fractures: the need to review the standard of care. Injury 2015; 46: 1084-1088 DOI: 10.1016/j.injury.2015.02.016. (PMID: 25840789)
• 20 Khursheed O, Wani MM, Rashid S. et al. Results of treatment of distal extra: articular femur fractures with locking plates using minimally invasive approach—experience with 25 consecutive geriatric patients. Musculoskelet Surg 2015; 99: 139-147
• 21 Horneff 3rd JG, Scolaro JA, Jafari SM. et al. Intramedullary nailing versus locked plate for treating supracondylar periprosthetic femur fractures. Orthopedics 2013; 36: e561-e566 DOI: 10.3928/01477447-20130426-16. (PMID: 23672906)
• 22 Lieder CM, Gaski GE, Virkus WW. et al. Is immediate weight-bearing safe after single implant fixation of elderly distal femur fractures?. J Orthop Trauma 2021; 35: 49-55 DOI: 10.1097/BOT.0000000000001882. (PMID: 32639392)
• 23 Zhao Z, Li Y, Ullah K. et al. The antegrade angle-stable locking intramedullary nail for type-C distal femoral fractures: a thirty four case experience. Int Orthop 2018; 42: 659-665 DOI: 10.1007/s00264-017-3747-0. (PMID: 29397414)
• 24 Biber R, Bail HJ. Retrograde Marknagelung bei periprothetischen Frakturen des distalen Femurs. Oper Orthop Traumatol 2014; 26: 438-454
• 25 Al Farii H, Cloutier J-P, AlQahtani S. et al. Endosteal substitution with medial plate in the treatment of acute distal femur fracture (AO/OTA type A): surgical technique and case-series. Eur J Orthop Surg Traumatol 2022; 32: 211-217 DOI: 10.1007/s00590-021-02945-x. (PMID: 33779830)
• 26 Park KH, Oh CW, Park KC. et al. Excellent outcomes after double-locked plating in very low periprosthetic distal femoral fractures. Arch Orthop Trauma Surg 2021; 141: 207-214 DOI: 10.1007/s00402-020-03655-5. (PMID: 33128096)
• 27 Liporace FA, Yoon RS. Nail plate combination technique for native and periprosthetic distal femur fractures. J Orthop Trauma 2019; 33: e64-e68 DOI: 10.1097/BOT.0000000000001332. (PMID: 30277982)
• 28 Hussain MS, Dailey SK, Avilucea FR. Stable fixation and immediate weight-bearing after combined retrograde intramedullary nailing and open reduction internal fixation of noncomminuted distal interprosthetic femur fractures. J Orthop Trauma 2018; 32: e237-e240 DOI: 10.1097/BOT.0000000000001154. (PMID: 29521874)
• 29 Bettin CC, Weinlein JC, Toy PC. et al. Distal femoral replacement for acute distal femoral fractures in elderly patients. J Orthop Trauma 2016; 30: 503-509 DOI: 10.1097/BOT.0000000000000600. (PMID: 27078131)
• 30 Rao B, Kamal T, Vafe J. et al. Distal femoral replacement for selective periprosthetic fractures above a total knee arthroplasty. Eur J Trauma Emerg Surg 2014; 40: 191-199 DOI: 10.1007/s00068-013-0347-6. (PMID: 26815900)
• 31 Fakler JK, Hepp P, Marquaß B. et al. Is distal femoral replacement an adequate therapeutic option after complex fractures of the distal femur?. Z Orthop Unfall 2013; 151: 173-179 DOI: 10.1055/s-0032-1328424. (PMID: 23619651)
• 32 Zhang Y, Zhao X, Tang Y. et al. Application of Ni-Ti Alloy connector for the treatment of comminuted coronal plane supracondylar-condylar femoral fractures: a retrospective review of 21 patients. BMC Musculoskelet Disord 2013; 14: 355 DOI: 10.1186/1471-2474-14-355. (PMID: 24341860)
• 33 Bel JC, Court C, Cogan A. et al. Unicondylar fractures of the distal femur. Orthop Traumatol Surg Res 2014; 100: 873-877 DOI: 10.1016/j.otsr.2014.10.005. (PMID: 25453913)
• 34 Kubiak EN, Beebe MJ, North K. et al. Early weight bearing after lower extremity fractures in adults. JAAOS-J Am Acad Orthop Surg 2013; 21: 727-738 DOI: 10.5435/JAAOS-21-12-727. (PMID: 24292929)
• 35 Wähnert D, Hoffmeier K, Fröber R. et al. Distal femur fractures of the elderly – different treatment options in a biomechanical comparison. Injury 2011; 42: 655-659 DOI: 10.1016/j.injury.2010.09.009. (PMID: 20951378)