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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

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

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.

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Data availability

Data and material were obtained from hospital records in the four hospitals that participated in this study: Caomplejo Asistencial Universitario de Palencia, Hospital Clínico San Carlos, Hospital Universitario Infanta Leonor and Hospital Universitario Clínico de Valladolid.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Orthopedic and Traumatology Department, Complejo Asistencial Universitario de Palencia, Avenida Donantes de sangre S/N, 34005, Palencia, Spain

    Iñigo SanJosé-Pardo & Juan Mingo-Robinet

  2. Orthopedic and Traumatology Department, Hospital Clínico San Carlos, Calle Profesor Martín Lagos, 2, 28040, Madrid, Spain

    José Antonio Valle-Cruz & Susana Donadeu-Sánchez

  3. Orthopedic and Traumatology Department, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal 3, 47003, Valladolid, Spain

    Héctor J. Aguado, Sergio País-Ortega & Juan Antonio Alonso Del Olmo

  4. Orthopedic and Traumatology Department, Hospital Universitario Infanta Leonor, Avenida Gran Vía del Este 80, 28031, Madrid, Spain

    Javier Montoya-Adarraga & Ángel Díez-Rodríguez

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  1. Iñigo SanJosé-Pardo
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Iñigo SanJosé-Pardo, Juan Mingo-Robinet, José Antonio Valle-Cruz, Susana Donadeu-Sánchez, Héctor J. Aguado, Sergio País-Ortega, Javier Montoya-Adarraga and Ángel Díez-Rodríguez. The first draft of the manuscript was written by Iñigo SanJosé-Pardo and reviewed by Juan Mingo-Robinet, and all authors commented on previous versions of the manuscript. Juan Antonio Alonso Del Olmo contributed to overall language and critical review of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Iñigo SanJosé-Pardo.

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Iñigo SanJosé-Pardo, Juan Mingo-Robinet, José Antonio Valle-Cruz, Susana Donadeu-Sánchez, Héctor J. Aguado, Sergio País-Ortega, Javier Montoya-Adarraga and Ángel Díez-Rodríguez declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

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SanJosé-Pardo, I., Valle-Cruz, J.A., Donadeu-Sánchez, S. et al. 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. Eur J Orthop Surg Traumatol (2024). https://doi.org/10.1007/s00590-024-03897-8

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