OTA 2013 Posters
Scientific Poster #20 Geriatric OTA 2013
Immediate Weight Bearing as Tolerated After Locked Plating of Fragility Fractures of the Femur
Seth Criner, DO; Jacqueline Krumrey, MD;
Good Samaritan Regional Medical Center, Corvallis, Oregon, USA
Purpose: This study was undertaken to evaluate whether locked periarticular femoral plates could withstand immediate weight bearing as tolerated following open reduction and internal fixation.
Methods: A total of 31 patients underwent locked femoral plating using the Smith & Nephew Peri-Loc system between 2007 and 2011. All surgery was performed by a single surgeon. Patients included were those who were physiologically aged and sustained a ground level fall resulting in a femur fracture. Patients were either kept non–weight bearing (NWB) for a minimum of 6 weeks or allowed immediate weight bearing as tolerated (WBAT). Charts and radiographs were retrospectively reviewed. Two patients were lost to follow-up in the NWB group and two patients were lost to follow-up in the WBAT group, leaving a total of 27 patients for review. Mortality rate was reviewed at 6, 12, and 13 months. Radiographs were reviewed for fracture healing and hardware failure.
Results: We had 13 patients in the NWB group and 14 patients in the WBAT group. There was no significant difference between the two groups for age, smoking, diabetes, or use of bisphosphonates. Two screws broke in one NWB patient at 9 months, and one screw broke in one WBAT patient at 10 months. This was not statistically significant. No patients had failure of fixation requiring reoperation. At 6 months, the mortality rate in the NWB group was 23% versus 0% in the WBAT group (P = 0.06, relative risk [RR] = 7.35; 95% confidence interval [CI] 0.45-207.9). At 13 months, the mortality rate in the NWB group was 39% versus 7% in the WBAT group (P = 0.05, RR = 5.39; 95% CI 0.72-40.20).
Conclusions: Our results suggest that patients with low energy femur fractures may safely weight-bear as tolerated following fixation with the Smith & Nephew Peri-Loc system. There is a trend toward decreased mortality at 6 months following fracture fixation for patients allowed immediate weight bearing as tolerated, and a statistically significant difference in mortality at 13 months following fracture fixation for patients allowed immediate weight bearing as tolerated. Weaknesses of our study include retrospective design and small numbers. We cannot extrapolate our hardware failure data to other brands of locked plating systems. Because early mobilization appears to decrease the mortality rate in this elderly population, our study warrants further investigation into immediate weight bearing as tolerated following locked fixation of femur fractures.• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.