Immediate Weightbearing through Walker or Crutches After Surgical Fixation of Clavicle Fractures in Patients with Lower Extremity Fractures: A Retrospective Cohort Study

Abstract

Objectives: To assess the safety of immediate upper extremity weightbearing as tolerated (WBAT) rehabilitation protocol after clavicle fracture open reduction internal fixation (ORIF). Methods: Design: Retrospective Cohort Study Setting: Three Level-One trauma centers Patients Selection Criteria: Patients greater than 18 years of age who had ORIF of mid-shaft clavicle fractures and lower extremity fractures who were allowed immediate WBAT on their affected upper extremity through use of a walker or crutches were included. All clavicles were fixed with either precontoured clavicular plates or locking compression plates. Included patients were, and clinical/radiographic follow-up until fracture union, nonunion, or construct failure. Outcome Measures and Comparisons: WBAT patients were matched in a one-to-one fashion to a cohort with isolated clavicle fractures who were treated non-weightbearing (NWB) postoperatively on their affected upper extremity. Matching was done based on age, sex, and temporality of fixation. After matching, treatment and control groups were compared to determine differences in possible confounding variables that could influence the primary outcome including patient demographics, fracture classification, cortices of fixation, and construct type. All patients were assessed to verify conformity with weight bearing recommendation. Primary outcome was early hardware failure with or without revision surgery. Secondary outcomes included post operative infections, and union of fracture. Result s: 39 patients were included in the WBAT cohort, there were no significant differences with the matched NWB cohort based on patient demographics, . Both the WBAT and NWB cohorts both had 2.5% chance of acute hardware failure (HWF) that required surgical intervention (p=1.0). Additionally, there was no difference in overall HWF (p=0.49). All patients despite weight bearing status including those that required revision ORIF for acute HWF had union of their fracture (p=1.0). Conclusions: Our data would support that immediate weightbearing after clavicle fracture fixation in patients with concomitant lower extremity trauma does not lead to an increase in hardware failure or impact ultimate union. This challenges the dogma of prolonged postoperative weightbearing restrictions and allow for earlier rehabilitation.