Outcomes of early versus delayed weight-bearing with intramedullary nailing of tibial shaft fractures: a systematic review and meta-analysis

doi:10.1007/s00068-022-01919-w

Meta-Analysis

. 2022 Oct;48(5):3521-3527.

doi: 10.1007/s00068-022-01919-w. Epub 2022 Mar 3.

Outcomes of early versus delayed weight-bearing with intramedullary nailing of tibial shaft fractures: a systematic review and meta-analysis

Affiliations

¹ Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
² Discipline of Surgery, University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville, SA, 5011, Australia.
³ University of Adelaide, Adelaide, South Australia, Australia.
⁴ Discipline of Surgery, University of Adelaide, Women's and Children's Hospital, Adelaide, South Australia, Australia.
⁵ Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
⁶ Department of Surgery, Lyell McEwin Hospital, Adelaide, South Australia, Australia.
⁷ School of Public Health, Adelaide Health Technology Assessment, University of Adelaide, Adelaide, South Australia, Australia.
⁸ Flinders Medical Centre, Department of Orthopaedics and Trauma, Adelaide, South Australia, Australia.
⁹ College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
¹⁰ Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia. christy.graff@sa.gov.au.
¹¹ Discipline of Surgery, University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville, SA, 5011, Australia. christy.graff@sa.gov.au.
¹² Discipline of Surgery, University of Adelaide, Women's and Children's Hospital, Adelaide, South Australia, Australia. christy.graff@sa.gov.au.

PMID: 35238986
PMCID: PMC9532312
DOI: 10.1007/s00068-022-01919-w

Meta-Analysis

Outcomes of early versus delayed weight-bearing with intramedullary nailing of tibial shaft fractures: a systematic review and meta-analysis

Ameya Bhanushali et al. Eur J Trauma Emerg Surg. 2022 Oct.

. 2022 Oct;48(5):3521-3527.

doi: 10.1007/s00068-022-01919-w. Epub 2022 Mar 3.

Authors

Affiliations

¹ Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
² Discipline of Surgery, University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville, SA, 5011, Australia.
³ University of Adelaide, Adelaide, South Australia, Australia.
⁴ Discipline of Surgery, University of Adelaide, Women's and Children's Hospital, Adelaide, South Australia, Australia.
⁵ Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
⁶ Department of Surgery, Lyell McEwin Hospital, Adelaide, South Australia, Australia.
⁷ School of Public Health, Adelaide Health Technology Assessment, University of Adelaide, Adelaide, South Australia, Australia.
⁸ Flinders Medical Centre, Department of Orthopaedics and Trauma, Adelaide, South Australia, Australia.
⁹ College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
¹⁰ Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia. christy.graff@sa.gov.au.
¹¹ Discipline of Surgery, University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville, SA, 5011, Australia. christy.graff@sa.gov.au.
¹² Discipline of Surgery, University of Adelaide, Women's and Children's Hospital, Adelaide, South Australia, Australia. christy.graff@sa.gov.au.

PMID: 35238986
PMCID: PMC9532312
DOI: 10.1007/s00068-022-01919-w

Abstract

Purpose: Early weight bearing (EWB) is often recommended after intramedullary nailing of tibial shaft fractures, however, the risks and benefits have not been critically evaluated in a systematic review or meta-analysis. Therefore, the aims of this study were to perform a systematic review and meta-analysis comparing EWB and delayed weight-bearing (DWB) after intramedullary nailing of tibial shaft fractures and assess the relationship between weight-bearing, fracture union and healing.

Method: This review included studies comparing the effects of EWB, defined as weight-bearing before 6 weeks, and DWB on fracture union and healing. PubMed, Embase, CINAHL, and the Cochrane Library were searched from inception to 9 May 2021. Risk of bias was assessed using the Down's and Black Checklist and Cochrane Risk of Bias Tool 2.0. Data were synthesised in a meta-analysis, as well as narrative and tabular synthesis.

Results: Eight studies were included for data extraction and meta-analysis. The analysis produced mixed results and found a significant decrease in mean union time (-2.41 weeks, 95% confidence interval: -4.77, -0.05) with EWB and a significant Odd's Ratio (OR) for complications with DWB (OR: 2.93, 95% CI: 1.40, 6.16). There was no significant difference in rates of delayed union, non-union, re-operation and malunion.

Conclusion: The included studies were of moderate risk of bias and demonstrated shorter union time and fewer complications with EWB. However, current evidence is minimal and has significant limitations. The role of EWB in high-risk patients is yet to be examined. Further well-designed, randomised studies are required on the topic.

Keywords: Early weight-bearing; Fracture union; Intramedullary nail; Tibial shaft; Trauma; Weight-bearing.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest to disclose.

Cited by

Causal Link between Gut Microbiota, Neurophysiological States, and Bone Diseases: A Comprehensive Mendelian Randomization Study.
Luo S, Chen Z, Deng L, Chen Y, Zhou W, Canavese F, Li L. Luo S, et al. Nutrients. 2023 Sep 11;15(18):3934. doi: 10.3390/nu15183934. Nutrients. 2023. PMID: 37764718 Free PMC article.
Weight-Bearing Versus Non-Weight-Bearing After Ankle Fracture: A Systematic Review and Meta-Analysis of Patient-Reported Outcome.
Llombart-Blanco R, Mariscal G, Khalil I, Cordón V, Benlloch M, Barrios C, Llombart-Ais R. Llombart-Blanco R, et al. Life (Basel). 2025 Feb 18;15(2):314. doi: 10.3390/life15020314. Life (Basel). 2025. PMID: 40003723 Free PMC article. Review.
Effect of early weight bearing program with conventional physiotherapy on functional outcomes in surgically treated proximal tibia fracture: a pilot randomized controlled trial.
Kadam A, Wani S, Gadekar G, Katage G, Garg K, Mungikar S. Kadam A, et al. Arch Orthop Trauma Surg. 2024 Jun;144(6):2481-2489. doi: 10.1007/s00402-024-05347-w. Epub 2024 May 2. Arch Orthop Trauma Surg. 2024. PMID: 38693286 Clinical Trial.

References

1. Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37(8):691–697. doi: 10.1016/j.injury.2006.04.130. - DOI - PubMed
1. TA. R. Fractures of the tibial diaphysis. Orthopaedic knowledge update: trauma 1 1. Rosemont, Il: American Academy of Orthopaedic Surgeons; 1996. p. 171–9.
1. Bhandari M, Guyatt G, Tornetta P, Schemitsch EH, Swiontkowski M, Sanders DW. Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Joint Surg Am. 2008;90(12):2567–2578. doi: 10.2106/JBJS.G.01694. - DOI - PMC - PubMed
1. Bong MR, Kummer FJ, Koval K, Egol KA. Intramedullary nailing of the lower extremity: biomechanics and biology. J Am Acad Orthop Surg. 2007;15:97–106. doi: 10.5435/00124635-200702000-00004. - DOI - PubMed
1. Duan X, Al-Qwbani M, Zeng Y, Zhang W, Xiang Z. Intramedullary nailing for tibial shaft fractures in adults. Cochrane Database Syst Rev. 2012;18:CD008241. - PMC - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information

[1] Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37(8):691–697. doi: 10.1016/j.injury.2006.04.130. - DOI - PubMed

[2] Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37(8):691–697. doi: 10.1016/j.injury.2006.04.130. - DOI - PubMed

[3] TA. R. Fractures of the tibial diaphysis. Orthopaedic knowledge update: trauma 1 1. Rosemont, Il: American Academy of Orthopaedic Surgeons; 1996. p. 171–9.

[4] TA. R. Fractures of the tibial diaphysis. Orthopaedic knowledge update: trauma 1 1. Rosemont, Il: American Academy of Orthopaedic Surgeons; 1996. p. 171–9.

[5] Bhandari M, Guyatt G, Tornetta P, Schemitsch EH, Swiontkowski M, Sanders DW. Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Joint Surg Am. 2008;90(12):2567–2578. doi: 10.2106/JBJS.G.01694. - DOI - PMC - PubMed

[6] Bhandari M, Guyatt G, Tornetta P, Schemitsch EH, Swiontkowski M, Sanders DW. Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Joint Surg Am. 2008;90(12):2567–2578. doi: 10.2106/JBJS.G.01694. - DOI - PMC - PubMed

[7] Bong MR, Kummer FJ, Koval K, Egol KA. Intramedullary nailing of the lower extremity: biomechanics and biology. J Am Acad Orthop Surg. 2007;15:97–106. doi: 10.5435/00124635-200702000-00004. - DOI - PubMed

[8] Bong MR, Kummer FJ, Koval K, Egol KA. Intramedullary nailing of the lower extremity: biomechanics and biology. J Am Acad Orthop Surg. 2007;15:97–106. doi: 10.5435/00124635-200702000-00004. - DOI - PubMed

[9] Duan X, Al-Qwbani M, Zeng Y, Zhang W, Xiang Z. Intramedullary nailing for tibial shaft fractures in adults. Cochrane Database Syst Rev. 2012;18:CD008241. - PMC - PubMed

[10] Duan X, Al-Qwbani M, Zeng Y, Zhang W, Xiang Z. Intramedullary nailing for tibial shaft fractures in adults. Cochrane Database Syst Rev. 2012;18:CD008241. - PMC - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Outcomes of early versus delayed weight-bearing with intramedullary nailing of tibial shaft fractures: a systematic review and meta-analysis

Affiliations

Outcomes of early versus delayed weight-bearing with intramedullary nailing of tibial shaft fractures: a systematic review and meta-analysis

Authors

Affiliations

Abstract

Conflict of interest statement

Similar articles

Cited by

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Abstract

Conflict of interest statement

Similar articles

Cited by

References

Publication types

MeSH terms

Related information

LinkOut - more resources

Full Text Sources

Medical