DOS BULLETIN - Dansk Ortopædisk Selskab

2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 92
Can immediate weight bearing be allowed following
locking plate osteosynthesis of proximal tibial fractures?
Tobias Haak, Henrik Palm, Kim Holck,
Michael Krasheninnikoff, Peter Gebuhr, Anders Troelsen
Hvidovre University Hospital
Background: Traditionally, immediate weight bearing following osteosynthesis
of proximal tibial fractures is not allowed due to fear of intraarticular
fracture collapse. Locking plates could however improve stability
of osteosynthesis and optimize support of the articular surfaces.
Thus, allowing greater loading forces.
Purpose: To investigate if immediate weight bearing can be allowed following
locking plate osteosynthesis of proximal tibial fractures.
Methods: We retrospectively assessed all locking plate osteosynthesis of
proximal tibial fractures operated from Nov. 2007 to Sep. 2009. Patient
demographics, complications, reoperations and radiographic outcome at
6-8 week follow-up were assessed. The study group consisted of 42 patients
(23 females/19 men) with a mean age of 50 yrs (range: 21-88 yrs).
The median ASA score was 1 (range: 1-3) and cognitive impairment was
found in 2 patients. The fracture distribution was: Partial intraarticular
AO type 41B (n=36); Complete intraarticular AO type 41C3 (n=4);
Extraarticular AO type 41A (n=2). Two groups were compared: 26 patients
were not allowed to bear weight within the first 6-8 weeks, and 16
were allowed to bear weight immediately postoperative.
Findings: Groups were comparable with respect to demographic parameters
and distribution of fracture types (p=0.14- 0.95). The use of bone
allograft, the number of screws inserted, and the application of postoperative
Don-Joy bandage were comparable between groups (p= 0.17, 0.73
and 0.55). Overall, persisting depressions of the articular surface ranged
from 0-5 mm postoperatively with no difference between groups
(p=0.26). At follow-up 6-8 weeks postoperative no patients were reoperated,
and no changes in radiographic configuration of the fracture site
were observed in either group.
Conclusion: Given the retrospective design it seems that immediate
weightbearing following locking plate osteosynthesis of proximal tibial
AO type 41B fractures can be allowed. Future prospective studies are
needed.
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