Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy)..
UNITS, Ospedale di Cattinara, ASUGI.
Acta Biomed. 2021 Sep 2;92(4):e2021236. doi: 10.23750/abm.v92i4.10787.
The incidence of pelvic and acetabular fractures is increasing during the years, counting 37 pelvic fractures per 100000 people annually. No weight bearing or toe touch weight bearing are usually chosen in the initial management to allow fracture and ligamentous healing and avoid fracture displacement and fixation failure. On the other hand, early weight bearing may stimulate fracture healing and allow prompt functional recovery, faster return to work and recreational activities and reduce complications linked to late rehabilitation. Aim of the study is to review the literature about weight bearing indications for pelvic and acetabular fractures to highlight clinical and biomechanical evidence supporting early weight bearing.
Two independent reviewers independently extracted studies on early weight bearing of pelvic and acetabular fractures. All selected studies were screened independently based on title and abstract. Then the full text of any article that either judged potentially eligible was acquired and reviewed again. Any disagreement was resolved by discussing the full text manuscripts.
44 studies including reviews, meta-analysis, clinical and biomechanical studies were selected.
Despite biomechanical data, few clinical evidences can be found to support early weight bearing in pelvic and especially acetabular fractures treatment. The promising results of some clinical experiences, however, should direct further studies to clearly define the indications and limits of early weight bearing in these injuries. Recognizing intrinsic lesion stability and bone and fixation technique quality, together with patient age and compliance, should be the mainstay for post-operative management choice.
近年来，骨盆和髋臼骨折的发病率不断增加，每年每 10 万人中有 37 例骨盆骨折。在初始管理中，通常选择不负重或仅足尖负重，以允许骨折和韧带愈合，并避免骨折移位和固定失败。另一方面，早期负重可能会刺激骨折愈合，允许更快的功能恢复，更快地返回工作和娱乐活动，并减少与晚期康复相关的并发症。本研究的目的是回顾关于骨盆和髋臼骨折负重指征的文献，以强调支持早期负重的临床和生物力学证据。
两位独立的审查员分别从骨盆和髋臼骨折的早期负重研究中提取研究。根据标题和摘要独立筛选所有选定的研究。然后，获取并再次审查任何被认为有潜在资格的文章的全文。任何分歧都通过讨论全文手稿来解决。
共纳入 44 项研究，包括综述、荟萃分析、临床和生物力学研究。
尽管有生物力学数据，但很少有临床证据支持骨盆骨折，特别是髋臼骨折治疗中的早期负重。然而，一些临床经验的有希望的结果应该指导进一步的研究，以明确确定这些损伤中早期负重的指征和限制。认识到内在损伤稳定性和骨与固定技术质量，以及患者年龄和依从性，应是术后管理选择的主要依据。
