Session V - Knee / Tibia

Fri., 10/11/13 Knee/Tibia, PAPER #63, 3:10 pm OTA 2013

Can All Tibial Shaft Fractures Bear Weight Following Intramedullary Nailing? A Randomized Clinical Trial

Steven C. Gross, MD1; David Taormina, MS2; Kenneth A. Egol, MD3;
Nirmal C. Tejwani, MD3;
1Carolinas Medical Center, Greensboro, North Carolina, USA;
2New York Medical College, Valhalla, New York, USA;
3NYU Hospital for Joint Diseases, New York, New York, USA

Background/Purpose: There currently exists no consensus regarding the appropriate postoperative weight-bearing status following intramedullary (IM) nailing of tibial shaft fractures. This prospective randomized study was designed to examine the potential benefits or risks associated with immediate postoperative weight bearing versus non–weight bearing. The null hypothesis was that early weight-bearing status had no effect on outcome following tibial nailing.

Methods: Over a 2.5-year period 60 tibial shaft fractures (OTA Type 42) indicated for surgical treatment with an IM nail that met inclusion criteria were identified. Patients were asked to consent to randomization of their postoperative protocol. Patients were randomized to one of two groups: immediate weight bearing as tolerated (WBAT), or non–weight bearing for the first 6 postoperative weeks (NWB). Regular follow-up was obtained, including radiographs. The Short Musculoskeletal Function Assessment (SMFA) questionnaire was used to record functional outcomes at regular intervals. Patients were followed until union or until treatment failure/revision surgery. All complications were recorded.

Results: A total of 46 patients with 48 tibia fractures had complete follow-up. The WBAT and NWB groups did not differ with regard to demographics, ISS, open/closed fracture status, or fracture pattern. There was no difference in the observed time to union between groups. Rates of complications, including hardware failure and delayed/nonunion, did not differ between groups. No incidents of significant loss of reduction leading to malunion were recorded. SMFA scores for all domains were similar between groups, both at 6 weeks postoperatively and at union.

Conclusion: Immediate weight bearing following IM nailing of tibial shaft fractures is safe and is not associated with an increase in adverse events or complications. Patients should be allowed to bear weight as tolerated following IM nailing. This has potential implications in improving patient satisfaction, earlier return to work, and faster rehabilitation.

Alphabetical Disclosure Listing

• 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.