Main Article Content
Early weight bearing, acetabular fracture, pelvic fracture, weight bearing
Background and aim of the work: The incidence of pelvic and acetabular fractures is increasing during the years, counting 37 pelvic fractures per 100000 people annually. No weight bearing or toe touch weight bearing are usually chosen in the initial management to allow fracture and ligamentous healing and avoid fracture displacement and fixation failure. On the other hand, early weight bearing may stimulate fracture healing and allow prompt functional recovery, faster return to work and recreational activities and reduce complications linked to late rehabilitation. Aim of the study is to review the literature about weight bearing indications for pelvic and acetabular fractures to highlight clinical and biomechanical evidence supporting early weight bearing.
Methods: Two independent reviewers independently extracted studies on early weight bearing of pelvic and acetabular fractures. All selected studies were screened independently based on title and abstract. Then the full text of any article that either judged potentially eligible was acquired and reviewed again. Any disagreement was resolved by discussing the full text manuscripts.
Results: 44 studies including reviews, meta-analysis, clinical and biomechanical studies were selected.
Conclusions: Despite biomechanical data, few clinical evidences can be found to support early weight bearing in pelvic and especially acetabular fractures treatment. The promising results of some clinical experiences, however, should direct further studies to clearly define the indications and limits of early weight bearing in these injuries. Recognizing intrinsic lesion stability and bone and fixation technique quality, together with patient age and compliance, should be the mainstay for post-operative management choice.
2. Ruedi TP, Buckely RE, Moran CG. AO principles of fracture management. 2nd edition. New York: Thieme; 2008.
3. Hustedt JW, Blizzard DJ, Baumgaertner MR, et al. Is it possible to train patients to limit weight bearing on a lower extremity? Orthopedics. 2012; 35: 31–7.
4. Meys G, Kalmet P, Sanduleanu S, van Horn Y, Maas GJ, Poeze M, et al. A protocol for permissive weight-bearing during allied health therapy in surgically treated fractures of the pelvis and lower extremities. J Rehabil Med. 2019; 51(4): 290-297
5. Yoshida H1, Faust A, Wilckens J, Kitagawa M, Fetto J, Chao EY. Three-dimensional dynamic hip contact area and pressure distribution during activities of daily living. J Biomech. 2006;39(11): 1996-2004.
6. Bergmann G, Deuretzbacher G, Heller M, Graichen F, Rohlmann A, Strauss J et al. Hip contact forces and gait patterns from routine activities. J Biomech. 2001; 34: 859-71.
7. Magee DJ, Zachazewski JE, Quillen WS. Scientific foundations and principles of practice in musculoskeletal rehabilitation. St Louis: Saunders Elsevier; 2007.
8. Tile M, Pennal GF. Pelvic disruption: Principles of management. Clin Orthop Relat Res 1980; 151: 56-64.
9. Young JWR, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology. 1986; 160: 445–451.
10. Küper MA, Trulson A, Stuby FM, Stöckle U. Pelvic ring fractures in the elderly. EFORT Open Rev. 2019; 4: 313-320.
11. Matta JM. Indications for anterior fixation of pelvic fractures. Clin Orthop Relat Res 1996; 329: 88-96.
12. Gill J, Murphy C, Quansah B, Carrothers A. Management of the open book APC II pelvis: Survey results from pelvic and acetabular surgeons in the United Kingdom. J Orthop. 2017; Aug 9; 14(4): 530-536.
13. Bruce B, Reilly M, Sims S. OTA Highlight Paper Predicting Future Displacement of Nonoperatively Managed Lateral Compression Sacral Fractures: Can It Be Done?. J Orthop Trauma. 2011; 25: 523-7.
14. Langford J, Burgess A, Liporace F, Haidukewych G. Pelvic Fractures: Part 2. Contemporary Indications and Techniques for Definitive Surgical Management. J Am Acad Orthop Surg. 2013; 21: 458-468.
15. Wojahn R, Gardner M. Fixation of Anterior Pelvic Ring Injuries. J Am Acad Orthop Surg. 2019; 27: 667-676.
16. Tile M, Pennal GF. Pelvic disruption: Principles of management. Clin Orthop Relat Res 1980; 151: 56-64.
17. Schildhauer TA, Josten C, Muhr G. Triangular osteosynthesis of vertically unstable sacrum fractures: a new concept allowing early weight-bearing. J Orthop Trauma. 2006; 20 (Suppl.1): 44–51.
18. Verbeek D, Routt M. High-Energy Pelvic Ring Disruptions with Complete Posterior Instability: Contemporary Reduction and Fixation Strategies. J Bone Joint Surg Am. 2018; 100: 1704-1712.
19. Mouhsine E, Garofalo R, Borens O, Wettstein M, Blanc CH, Fischer JF, et al. Percutaneous retrograde screwing for stabilization of acetabular fractures. Injury. 2005; 36(11): 1330-6.
20. Kazemi N, Archdeacon MT. Immediate full weight bearing after percutaneous fixation of anterior column acetabulum fractures. J Orthop Trauma. 2012; 26: 73–9.
21. Bozzio A, Wydra F, Mitchell J, Ackerson R, Mauffrey C. Percutaneous Fixation of Anterior and Posterior Column Acetabular Fractures. Orthopedics. 2014; 37: 675-678.
22. Gänsslen A, Krettek C. Internal fixation of acetabular both-column fractures via the ilioinguinal approach. Oper Orthop Traumatol. 2009; 21(3): 270-82.
23. Caviglia H, Mejail A, Landro ME, Vatani N. Percutaneous fixation of acetabular fractures. EFORT Open Rev. 2018; 3: 326–34.
24. Heare A, Kramer N, Salib C, Maufrey C. Early versus late weight-bearing protocols for surgically managed posterior wall acetabular fractures. Orthopedics. 2017; 40(4): e652–e657.
25. Gaston MS, Simpson AH. Inhibition of fracture healing. J Bone Joint Surg Br. 2007; 89: 1553-1560.
26. Hernandez RK, Do TP, Critchlow CW, Critchlow CW, Dent RE, Jick SS. Patient-related risk factors for fracture-healing complications in the United Kingdom General Practice Research Database. Acta Orthop. 2012; 83: 653–660.
27. Matta JM. Fractures of the acetabulum; accuracy of reduction and clinical results in patients managed operatively within three weeks after the Injury. J Bone Joint Surg Am. 1996; 78: 1632–45.
28. Tannast M, Najibi S, Matta JM. Two to twenty-year survivorship of the hip in 810 patients with operatively treated acetabular fractures. J Bone Joint Surg Am. 2012; 94(17):1559–67.
29. Westerman R, Hull P, Hendry RG, Cooper J. The physiological cost of restricted weight bearing. Injury. 2008;39. 725-7. 10.1016/j.injury.2007.11.007.
30. North K, Potter MQ, Kubiak EN, Bamberg SJ, Hitchcock RW. The effect of partial weight bearing in a walking boot on plantar pressure distribution and center of pressure. Gait Posture. 2012; 36(3): 646–9.
31. Kammerlander C, Pfeufer D, Lisitano L, Mehaffey S, Böcker W, Neuerburg C. Inability of Older Adult Patients with Hip Fracture to Maintain Postoperative Weight-Bearing Restrictions. J Bone Joint Surg Am. 2018; 100: 936-941.
32. Zhang L, Yin P, Zhang W, Li T, Li J, Chen H et al. An Effective and Feasible Method, “Hammering Technique,” for Percutaneous Fixation of Anterior Column Acetabular Fracture. BioMed Res Int. 2016; 1-6.
33. Magu NK, Gogna P, Singh A, Singla R, Rohilla R, Batra A, et al. Long term results after surgical management of posterior wall acetabular fractures. J Orthop Traumatol. 2014; 15: 173–179.
34. Cochu G, Mabit C, Gougam T, Fiorenza F, Baertich C, Charissoux JL, et al. Total hip arthroplasty for treatment of acute acetabular fracture in elderly patients. Rev Chir Orthop. 2007; 93: 818–27.