Evaluation of a Novel Immediate Graded Weight-bearing Protocol and its Effect on the Formation of Fracture Callus in Femoral Shaft Fractures Fixed with Intramedullary Interlocking Nails: A Prospective Interventional Cohort Study
Aim and background: We formulated a novel immediate graded weight-bearing postoperative protocol for femoral fractures fixed with nails and aim to determine the safety and efficacy of the same and its effect on callus formation, fracture healing, functional outcomes, and implant failure rate. Materi...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Jaypee Brothers Medical Publisher
2025-07-01
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| Series: | Journal of Orthopedics and Joint Surgery |
| Subjects: | |
| Online Access: | https://www.jojs.in/doi/JOJS/pdf/10.5005/jojs-10079-1207 |
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| Summary: | Aim and background: We formulated a novel immediate graded weight-bearing postoperative protocol for femoral fractures fixed with nails and aim to determine the safety and efficacy of the same and its effect on callus formation, fracture healing, functional outcomes, and implant failure rate.
Materials and methods: This prospective interventional cohort study was done at a medical college hospital between October 2019 and April 2023. Patients with femoral shaft fractures underwent nailing. They were grouped based on the Winquist and Hansen classification (WHC). Type I and II fractures were allotted to group A, and type III and IV fractures were allotted to group B. Group A patients were made to bear a minimum weight of 25 kg, and group B a minimum weight of 15 kg through the operated limb. Radiological union was assessed using the modified RUST score (mRUST), and functional outcome using the Thoreson scoring method.
Results: We had 43 patients, with a mean age of 32.86 years. Based on the WHC, we had 15 type I, 16 type II, 8 type III, and 4 type IV fractures. We had an average mRUST score of 11.51 at the end of 6 weeks for the entire population. We found no significant difference between the mRUST score and time to union in each Winquist type. As per the Thoreson scoring system, the results were excellent in 34 cases (79.07%), good in 6 cases (13.95%), and fair in 3 cases (6.98%). We did a subgroup analysis comprising 24 patients with computed tomography (CT) to measure the volume of callus formation and found that the volume of callus increased with the increase in severity of comminution.
Conclusion: Our novel weight-bearing protocol proves that graded weight-bearing is safe and effective, despite comminution, without implant failure.
Clinical significance: Early graded weight-bearing promotes faster healing and fracture union. |
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| ISSN: | 2582-7863 |