Weight Bearing Protocol After Intramedullary Nail Fixation of Femur Fracture
Patients should be instructed to use weight bearing as tolerated immediately after intramedullary nail fixation of femur fractures, with assistive devices initially and gradually discontinued as comfort allows. 1
Immediate Post-Operative Weight Bearing
- The American Academy of Orthopaedic Surgeons recommends immediate, full weight bearing as tolerated after surgery for patients with femoral fractures treated with intramedullary fixation 1
- Early weight bearing allows quicker return to activities during the first 6 months compared to traditional non-weight bearing protocols 1, 2
- Studies show statistical improvements in time to return to activities including work, sports, and normal walking with early weight bearing protocols 1, 3
- Immediate weight bearing as tolerated has been shown to reduce hospital length of stay without increasing complication rates 3
Clinical Implementation
- Patients should begin weight bearing as tolerated immediately post-operatively with appropriate assistive devices (crutches, walker) 1
- Physical therapy should focus on gait training with proper weight bearing technique 1
- Assistive devices should be gradually discontinued as patient comfort and stability improve 1
- Patients naturally self-limit their weight bearing in the early postoperative period - studies show they typically bear only about 51% of normal weight on the injured limb at one week, gradually increasing to 87% by twelve weeks 4
Special Considerations
- For unstable fracture patterns, ensure adequate fixation has been achieved with appropriate locking techniques before allowing full weight bearing 5
- In elderly patients with osteoporotic bone, intramedullary nailing with locking screws introduced by a minimally-invasive technique and augmented by bone cement (if necessary) allows immediate full weight-bearing 5
- For distal femur fractures, early weight bearing has not been associated with increased risk of fracture displacement or implant failure when proper fixation techniques are used 2, 6
- In geriatric patients (≥75 years), early full weight bearing has been shown to better preserve gait function and reduce postoperative complications compared to non-weight bearing protocols 6
Monitoring and Follow-up
- Regular radiographic follow-up should be performed to ensure maintenance of reduction and progressive healing 1
- Clinical assessment of pain, function, and gait pattern should be performed at each follow-up visit 1
- Patient compliance with weight bearing recommendations is often poor - studies show only about 47% of patients comply with prescribed weight bearing limitations 7
- Deviation from weight bearing recommendations typically increases over time, with patients exceeding recommended limits by over 50% within two weeks after surgery 7
Potential Pitfalls
- Despite physical therapy training, weight-bearing compliance to recommended limits is often low, so uncontrolled weight-bearing restrictions should be viewed with caution 7
- Patients with distal femur fractures treated with locking plates can safely begin early weight bearing without increased risk of complications 2, 6
- Non-weight bearing protocols may actually delay fracture healing and increase the risk of fixation failure in some cases 2