Effect of postoperative weight-bearing timing on functional and radiological outcomes in distal tibial metaphyseal fractures: A retrospective cohort study.

Abstract

The optimal timing of postoperative weight bearing after distal tibial metaphyseal fractures remains controversial, particularly in patients treated with plate fixation. 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). Retrospective cohort study. 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. 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. 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.