Effect of Immediate Weight Bearing after Intramedullary Fixation of Geriatric Subtrochanteric Fractures: A Retrospective Cohort Study

Introduction:
Intertrochanteric fractures in the elderly population are treated surgically and allowed immediate weight bearing to improve ambulation and lower complications and mortality. Subtrochanteric fractures are less stable and were traditionally treated with non-weight bearing. This study compares immediate weight bearing vs. limited or non-weight bearing with regards to patient outcomes.

Methods:
We analyzed all consecutive cases of low energy subtrochanteric fractures treated surgically at our institution between January 2018 and November 2020, and we compared immediate vs delayed weight bearing with regards to length of stay, time to painless ambulation, time to radiographic fracture union and revision rates. Fracture severity was also examined using the Seinsheimer classification

Results:
Length of stay (10.4 WBAT vs. 12.5 days delayed, P=0.26) and time to radiographic union (7.5 WBAT vs. 8.2 months delayed, P= 0.65) were lower in the immediate weight bearing group. Time to painless ambulation was significantly shorter in the immediate weight bearing group (4.7 WBAT vs 10.4 months delayed; p < 0.01), and rate of complications was lower (8% WBAT vs. 28% delayed, p < 0.05). no significant difference in revision rates was found. Seinsheimer class of the fracture had no influence on the decision to allow weight bearing (p=0.7)

Conclusions:
This study shows that immediate weight bearing as tolerated allows shorter time to painless ambulation and less perioperative complications.