Aebischer Andrea S, Gouk Conor J C, Steer Richard
Department of Orthopaedic Surgery, Gold Coast University Hospital, Southport, Queensland, Australia.
ANZ J Surg. 2025 Jun;95(6):1108-1114. doi: 10.1111/ans.19288. Epub 2024 Oct 28.
The global standard of care for hip fracture surgery is early weight-bearing, but this has not extended to other lower extremity fractures in the elderly. Patients undergoing fixation of distal femur fractures are often prescribed weight-bearing restrictions, which may lead to deconditioning and other complications. The purpose of this study was to compare the outcomes and complication rates between patients permitted early versus restricted weight-bearing following distal femur fracture fixation.
Medline, Embase, Cochrane and Web of Science databases were searched for English language articles up to 21 October 2023, identifying 366 studies for screening. Comparative studies evaluating patients undergoing distal femur fracture fixation with early or restricted weight-bearing were included. Native knee and periprosthetic fractures were included.
Ten studies were included for analysis. Two studies provided Level II evidence, while the remaining eight studies provided Level III evidence. Cochrane risk of bias tools were utilized to assess study quality. Revision and complication rates were analyzed and reported as odds ratio. Sub-analysis was undertaken to address the heterogeneity in author definitions of weight-bearing. There was no statistically significant difference in the revision or complication rate between the two groups.
Early weight-bearing following distal femur fracture fixation in a predominantly elderly population does not demonstrate an increased rate of revision or complications compared to restricted weight-bearing. However, there are limitations to the available literature, and the strength of the findings is insufficient to provide strong recommendations for all patients. Future studies should employ standardized definitions and avoid partial or time-based restrictions.
髋部骨折手术的全球护理标准是早期负重，但这尚未推广至老年患者的其他下肢骨折。接受股骨远端骨折内固定术的患者通常被规定限制负重，这可能导致身体机能下降及其他并发症。本研究的目的是比较股骨远端骨折内固定术后允许早期负重与限制负重的患者的治疗效果和并发症发生率。
检索了Medline、Embase、Cochrane和Web of Science数据库中截至2023年10月21日的英文文章，共识别出366项研究用于筛选。纳入评估早期或限制负重的股骨远端骨折内固定术患者的比较研究。包括原发性膝关节骨折和假体周围骨折。
纳入10项研究进行分析。2项研究提供了II级证据，其余8项研究提供了III级证据。使用Cochrane偏倚风险工具评估研究质量。分析并报告翻修率和并发症发生率的比值比。进行亚组分析以解决作者对负重定义的异质性问题。两组之间的翻修率或并发症发生率无统计学显著差异。
在以老年人群为主的股骨远端骨折内固定术后，与限制负重相比，早期负重并未显示出更高的翻修率或并发症发生率。然而，现有文献存在局限性，研究结果的力度不足以对所有患者提供强有力的建议。未来的研究应采用标准化定义，并避免部分或基于时间的限制。
