Lommerse Marte I, Mennen Anna H M, Bloemers Frank W, Willems Hanna C, van Embden Daphne
Department of Trauma Surgery, Amsterdam UMC, Amsterdam, The Netherlands.
Amsterdam Bone Center, Amsterdam Musculoskeletal Sciences, Amsterdam UMC research institute, Amsterdam, The Netherlands.
EFORT Open Rev. 2025 Sep 4;10(9):718-725. doi: 10.1530/EOR-2024-0191.
While the incidence of acetabular fractures keeps rising among our older patient population, age-specific rehabilitation guidelines are lacking. Post-surgery weight-bearing is often restricted for 8-12 weeks to avoid secondary fixation failure. However, non- or restricted weight-bearing commonly results in atrophy, and older patients are at additional risk of long-term mobility and functionality loss. Therefore, if the risk of secondary fracture failure proves to be lower than currently believed, early or permissive weight-bearing might actually be the preferred treatment choice to advance fracture healing and decrease recovery time. This study aims to review the current literature on early weight-bearing outcomes of acetabular fractures in older adults.
A systematic search of two databases was conducted following PRISMA guidelines. Eligible studies reported on early weight-bearing outcomes of older patients after surgical management. Data were showed in tables alongside a narrative synthesis. Critical appraisal and risk-of-bias tools assessed the study quality.
Six studies were included with a retrospective or observational design, with a total of 147 patients averaging 64 years old. The majority of studies discussed early weight-bearing protocols after percutaneous fixation (PF), with heterogeneity in terminology across protocols.
Albeit limited and low in evidence, the included studies suggest that early weight-bearing might be a possible alternative for non- or minimally displaced fractures and displaced fractures after PF and open reduction internal fixation, respectively. When risk assessments and functional outcomes are appropriately investigated, early weight-bearing may help patients, especially older adults, avoid suffering and prolonged rehabilitation periods.
在我们的老年患者群体中，髋臼骨折的发病率持续上升，但缺乏针对特定年龄的康复指南。术后通常限制负重8至12周，以避免内固定失败。然而，不负重或限制负重通常会导致肌肉萎缩，老年患者还面临长期活动能力和功能丧失的额外风险。因此，如果二次骨折失败的风险被证明低于目前的认知，早期或允许负重实际上可能是促进骨折愈合和缩短恢复时间的首选治疗方法。本研究旨在综述目前关于老年髋臼骨折早期负重结果的文献。
按照PRISMA指南对两个数据库进行系统检索。纳入的研究报告了老年患者手术治疗后的早期负重结果。数据以表格形式呈现，并伴有叙述性综述。使用关键评价和偏倚风险工具评估研究质量。
纳入六项回顾性或观察性研究，共147例患者，平均年龄64岁。大多数研究讨论了经皮固定（PF）后的早期负重方案，各方案术语存在异质性。
尽管纳入的研究证据有限且质量不高，但表明早期负重可能分别是非移位或轻度移位骨折以及PF和切开复位内固定术后移位骨折的一种可行替代方案。当对风险评估和功能结果进行适当研究时，早期负重可能有助于患者，尤其是老年患者，避免痛苦和延长康复期。
