Immediate Weight-bearing for Distal Femur Fractures Fixed With a Lateral Locking Plate Is Associated With Decreased Short-term Complications Without Increased Failure Rates.

Abstract

Distal femur fractures historically required prolonged weight-bearing restrictions following fixation. Allowing immediate weight-bearing is gaining traction due to the benefits of early mobilization. This study compares postoperative complications of immediate weight-bearing as tolerated (WBAT) versus restricted weight-bearing (RWB) in distal femur fractures fixed with a lateral locking plate. A retrospective analysis was conducted on all patients who underwent lateral locking plate fixation for distal femur fractures between October 2011 and April 2022 at four hospitals. Data collected included fracture characteristics, weight-bearing status, 30-day complications, and 1-year mortality. Radiographic outcomes including implant failure, malunion, nonunion, and time to union were assessed. One hundred twenty-four patients met inclusion criteria. Immediate weight-bearing was permitted in 76 (61.3%). The WBAT group was older (83.2 vs 68.9 years, <i>P</i> < .001), had a lower body mass index (BMI) (28.1 vs 30.8, <i>P</i> = .037), and had fewer 30-day complications (7.9% vs 25.0%, <i>P</i> = .008). There was no difference in 30-day (6.3% vs 2.6%, <i>P</i> = .374) or 1-year mortality (14.6% vs 17.1%, .468). There was no difference in implant failure, malunion, nonunion, and time to union between groups. Logistic regression demonstrated lower 30-day complications with WBAT (OR 0.207, <i>P</i> = .041), lower BMI (OR 1.095, <i>P</i> = .040) and lower Charlson Comorbidity Index. (OR 1.547, <i>P</i> = .023). Immediate weight-bearing after lateral locking plate fixation for distal femur fractures is associated with fewer early postoperative complications compared to RWB. WBAT did not increase the rate of fixation failure, malunion, or nonunion.