Early Weight Bearing on Supracondylar Distal Femur Fractures in Elderly Patients
Condition: Distal Femur Fractures
MeSH terms: Fractures, Bone; Femoral Fractures; Femoral Fractures, Distal
Study type: Interventional

Summary: 
      The investigators will be looking at geriatric distal femur fractures. The investigators will
      prospectively enroll these patients and allow patients to either weight bear as tolerated or
      limit their weight bearing post operatively. The investigators will evaluate functional
      outcomes.
    

Detailed description: 
      Supracondylar femur fractures represent 4-7% of femur fractures. These are a common
      orthopaedic injury with an overall incidence of 37 per 100,000 person-years. These fractures
      are complex and challenging for orthopaedic surgeons. The fracture needs to be correctly
      reduced and, like nearly all fractures, fixed with enough stability to permit early joint
      motion. This allows for earlier patient rehabilitation, which can improve outcomes. There are
      a number of different fixation devices. Fixed angle implants such as retrograde
      intramedullary nails, angled blade plates, and 95-degree side plates have had good clinical
      outcomes with resistance to varus collapse. Recently, locking plates have become the standard
      method for distal femoral fracture fixation. Hendersen et al. provided a systematic review of
      locking plate fixation and demonstrated the range of complications as 0% to 32% and implant
      failure occurring late with 75% of failures occurring after 3 months and 50% occurring after
      6 months. Ricci et al. sought to determine risk factors associated with failure of locked
      plate fixation of distal femur fractures and found that 19% required reoperation. The risk
      factors for reoperation found in this study were diabetes, smoking, increased body mass
      index, shorter plate length and open fracture. Most factors are out of surgeon control but
      are important to evaluate when considering prognosis.

      After the fracture has been open reduced and internally fixed, there is debate on
      postoperative management of weight bearing. Weight bearing following fixation is generally
      restricted for 6 to 12 weeks until radiologic evidence of evidence demonstrates sufficient
      callous. This restricted weight bearing is primarily due to concerns of implant failure and
      loss of reduction. A study by Brumback et al. examined intramedullary nail fixation of distal
      femur fractures and concluded to allow full weight bearing of comminuted femoral shaft
      fractures with antegrade intramedullary nail. This study led surgeons to accelerate their
      rehabilitation protocols.

      The post-operative weight bearing recommendations for distal femur fractures treated with
      locking plate vary widely which motivated Granata et al. to evaluate the biomechanics of
      immediate weight bearing of distal femur fractures treated with locked plate fixation. They
      found that the fatigue limit of the locked plate constructs was 1.9 times body weight for an
      average 70-kilogram patient over a simulated 10-week postoperative course. Although this
      study could not fully support immediate weight bearing due to the fact that femoral loads
      during gait have been estimated to be around 2 times body weight, it demonstrated adequate
      hardware fixation with weight bearing.

      The benefits of early weight bearing are accelerated functional recovery, increased
      independence, decreased impact on the family, increased psychological benefits, reduced use
      of healthcare resources, decreased need for family intervention, and family to take care of
      the patient. The downside is the strength of fixation, the risk of implant failure, and the
      risk of loss of reduction. The goals are to evaluate the fracture, the complication rate, the
      mortality rate, and the risks of healthcare resources that have been used.
    

Intervention name(s): Non Weight bearing; Early Weight Bearing
Intervention type(s): Other; Other
Intervention description(s): The design will be a surgeon based prospective cohort supported in the literature to answer research questions in which surgeons may have a preferred treatment type. Each surgeon will treat study subjects by his or her single chosen method (weight bearing as tolerated post operatively versus non weight bearing).
The benefits of early weight bearing are accelerated functional recovery, increased independence, decreased impact on the family, increased psychological benefits, reduced use of healthcare resources, decreased need for family intervention, and family to take care of the patient.; The design will be a surgeon based prospective cohort supported in the literature to answer research questions in which surgeons may have a preferred treatment type. Each surgeon will treat study subjects by his or her single chosen method (weight bearing as tolerated post operatively versus non weight bearing).
The benefits of early weight bearing are accelerated functional recovery, increased independence, decreased impact on the family, increased psychological benefits, reduced use of healthcare resources, decreased need for family intervention, and family to take care of the patient.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: geriatric fractures