Immediate weight-bearing following clavicle fracture fixation with concurrent lower extremity fracture does not change outcomes

1. This retrospective cohort study found that immediate weight-bearing following clavicle fracture fixation in patients with concurrent lower extremity trauma does not impact rates of hardware failure (HWF) or fracture union, compared with non-weight bearing (NWB) patients with isolated clavicular fractures. 

Evidence Rating Level: 2 (Good)

Clavicle fractures are increasingly treated with open reduction internal fixation (ORIF). Postoperative care often involves 6 weeks of NWB, but in polytrauma cases with lower extremity injuries, NWB is challenging. This study compared immediate weight-bearing post-ORIF with standard NWB protocol to assess the impact on complications. 39 polytrauma patients, with concurrent lower extremity fractures, who used a walker or crutches for weight-bearing post-ORIF of their clavicle, were age (44±17 years) and sex (72% men) matched with a control group of 39 patients who followed a progressive rehabilitation protocol that restricted full weight-bearing until 6 weeks after their isolated clavicular fracture ORIF. There were no significant differences in plate number, type, fixation cortices, or screw count between groups (P > 0.05). However, there were notable variations in plate positioning and fixation type (P < 0.05), with the weight-bearing as tolerated (WBAT) group exhibiting higher proportions of isolated anterior plating and 90-90 fixation, while the NWB group more frequently received isolated superior plating. Additionally, there were differences in overall construct types (P = 0.03), with the WBAT group having more compression plating and the NWB group more commonly treated with lag screws with neutralization plates and bridge plating. There was no difference in overall HWF (WBAT group: 1 patient vs. NWB group: 2 patients; P = 0.49) with both groups having one patient (2.5%) necessitating surgical intervention due to acute hardware failure (P = 1.0).  Final union rates showed no significant difference between cohorts (P = 1.0). Overall, this study found that WBAT after clavicle ORIF in patients with concomitant lower extremity trauma does not increase HWF or impact fracture union. However, these results should be considered in the context of between-group variations in plate positioning, fixation type, and construct type, which may represent a potential treatment bias, as surgeons might have opted for stronger constructs for polytrauma patients in anticipation of weight-bearing through their fixation. 

Click to read the study in the Journal of Orthopaedic Trauma

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