The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons · 2026
Effect of postoperative weight-bearing timing on functional and radiological outcomes in distal tibial metaphyseal fractures: A retrospective cohort study.
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Bulut Mustafa, Soy Furkan
Аннотация
BACKGROUND: The optimal timing of postoperative weight bearing after distal tibial metaphyseal fractures remains controversial, particularly in patients treated with plate fixation.
PURPOSE: To evaluate the effect of postoperative weight-bearing timing on functional and radiological outcomes in distal tibial metaphyseal fractures treated with minimally invasive percutaneous plate osteosynthesis (MIPPO).
STUDY DESIGN: Retrospective cohort study.
METHODS: This retrospective cohort study included adult patients who underwent MIPPO plating for distal tibial metaphyseal fractures between 2019 and 2024. Fractures were classified as AO 43-A1, AO 43-A2, or AO 43-A3. Weight-bearing progression was documented from electronic records. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score at 6 and 12 months. Radiological outcomes included medial distal tibial angle (MDTA), anterior distal tibial angle (ADTA), time to union, and return to work. Multivariable linear regression identified predictors of 12-month AOFAS scores.
RESULTS: Fifty-eight patients were included. AOFAS scores at 6 months were comparable among AO subgroups, whereas a significant difference was observed at 12 months, with AO 43-A3 fractures demonstrating poorer outcomes. Time to union did not differ among groups, whereas return to work was delayed in AO 43-A3 fractures. In multivariable analysis, time to weight bearing was not independently associated with 12-month AOFAS scores, while fracture complexity and higher BMI were independent predictors of poorer outcome.
CONCLUSIONS: In distal tibial metaphyseal fractures treated with MIPPO plating, postoperative weight-bearing timing was not independently associated with functional outcomes. Long-term recovery was primarily influenced by fracture complexity and patient-related factors.
PURPOSE: To evaluate the effect of postoperative weight-bearing timing on functional and radiological outcomes in distal tibial metaphyseal fractures treated with minimally invasive percutaneous plate osteosynthesis (MIPPO).
STUDY DESIGN: Retrospective cohort study.
METHODS: This retrospective cohort study included adult patients who underwent MIPPO plating for distal tibial metaphyseal fractures between 2019 and 2024. Fractures were classified as AO 43-A1, AO 43-A2, or AO 43-A3. Weight-bearing progression was documented from electronic records. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score at 6 and 12 months. Radiological outcomes included medial distal tibial angle (MDTA), anterior distal tibial angle (ADTA), time to union, and return to work. Multivariable linear regression identified predictors of 12-month AOFAS scores.
RESULTS: Fifty-eight patients were included. AOFAS scores at 6 months were comparable among AO subgroups, whereas a significant difference was observed at 12 months, with AO 43-A3 fractures demonstrating poorer outcomes. Time to union did not differ among groups, whereas return to work was delayed in AO 43-A3 fractures. In multivariable analysis, time to weight bearing was not independently associated with 12-month AOFAS scores, while fracture complexity and higher BMI were independent predictors of poorer outcome.
CONCLUSIONS: In distal tibial metaphyseal fractures treated with MIPPO plating, postoperative weight-bearing timing was not independently associated with functional outcomes. Long-term recovery was primarily influenced by fracture complexity and patient-related factors.