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Meta-Analysis
. 2024 Dec;50(6):2807-2818.
doi: 10.1007/s00068-024-02550-7. Epub 2024 May 22.

Weightbearing versus non-weight bearing in geriatric distal femoral fractures: a systematic review and meta-analysis

Blaise Wardle  1   2   3 , Joseph T Lynch  4   5 , Thomas Staniforth  6 , Thomas Ward  4   6   5 , Paul Smith  4   6   5
Affiliations
Meta-Analysis

Weightbearing versus non-weight bearing in geriatric distal femoral fractures: a systematic review and meta-analysis

Blaise Wardle et al. Eur J Trauma Emerg Surg. 2024 Dec.

Abstract

Background: Demographics of patients who sustain geriatric distal femoral fractures (DFF) match those of patients with neck-of-femur fractures but have limited evidence with which to support post-operative weightbearing protocols.

Purpose: This systematic review sought to identify any difference in outcomes for elderly patients with DFF who were allowed early versus delayed weightbearing postoperatively.

Methods: DATA SOURCES: PubMed, Medline, Embase and The Cochrane Library, reference lists of retrieved articles.

Study selection: English language papers published between January 2010 and February 2023 with AO-OTA type 33A, B and C femoral fractures as well as Lewis and Rorabeck Type I and II periprosthetic DFF surgically treated with either a lateral locking plate or retrograde intramedullary nail and an average patient age of ≥ 60 years.

Data extraction: Studies were assessed for inclusion by two authors and quality was assessed using the MINORS tool.

Data synthesis: Sixteen studies were included, Meta-analysis of non-union, malunion, infection, delayed union and implant complications was performed using Microsoft Excel and the MetaXL extension. The data on return to mobility were presented in narrative form. The analyses demonstrated no difference between the early and delayed weightbearing groups.

Conclusions: There are no significant differences in complication rates between early versus delayed weightbearing after surgery for DFF in an elderly population. The study results are limited by high heterogeneity and low-quality studies. High quality, prospective studies are needed to determine the ideal postoperative weightbearing protocol.

Level of evidence: Level III, Systematic Review and Meta-analysis of Level III studies. International Prospective Register of Systematic Reviews registration-Prospero CRD42022371460.

Keywords: Complication; Distal femur; Fragility fracture; Non-union; Weight bearing.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Non-union by weightbearing
Fig. 3
Fig. 3
Malunion by weightbearing
Fig. 4
Fig. 4
Infection by weightbearing
Fig. 5
Fig. 5
Mortality by weightbearing
Fig. 6
Fig. 6
Thromboembolism by weightbearing
See this image and copyright information in PMC

References

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