Early versus delayed weight-bearing after open reduction and internal fixation for vancouver type-B periprosthetic femoral fractures: A multicenter retrospective study.

BACKGROUND

The timing of postoperative weight-bearing after open reduction and internal fixation (ORIF) for periprosthetic femoral fractures (PPFs) is unclear. Although early weight-bearing is widely encouraged after many lower extremity fractures, its safety in PPFs remains uncertain. This study compared outcomes between early and delayed full weight-bearing after ORIF for Vancouver type B PPFs.

METHODS

We retrospectively reviewed 125 patients aged ≥60 years who underwent ORIF for Vancouver type B1-B3 PPFs at 18 affiliated hospitals between 2010 and 2022. We excluded those with follow-up <6 months, pre-injury Parker Mobility Score ≤2, or initiation of full weight-bearing at ≥13 weeks postoperatively. 93 patients were included and were divided into two groups, the early weight-bearing (EWB) group, in which full weight-bearing was initiated within 5 weeks after surgery, and the delayed weight-bearing (DWB) group, in which at 6 weeks or later. To adjust for baseline differences between groups, propensity score algorithm was performed. After matching, we compared functional outcomes at final follow-up, radiographic union at 6 months assessed using the Radiographic Union Score (RUST), and complications between groups. Finally, 62 patients were included (EWB group, n = 31; DWB group, n = 31).

RESULTS

Baseline characteristics were comparable between groups. At final follow-up, the median Merle d'Aubigné score was 13 vs. 15 (p = 0.00377). The median RUST score at 6 months was 8 in the EWB group and 8 in the DWB group (p = 0.659). Complications did not differ between groups, and reoperation was performed in 1 patient in the EWB group and 2 patients in the DWB group.

CONCLUSIONS

Delayed weight-bearing after ORIF for Vancouver type B PPFs was associated with superior functional outcomes. These findings suggest that routine early weight-bearing after ORIF for Vancouver type B fractures may not provide functional benefit.