Immediate weightbearing after intramedullary fixation of extra-articular distal tibial fractures reduces the nonunion rate compared with traditional weight-bearing protocol: A cohort study.

OBJECTIVES: To investigate whether immediate weightbearing after intramedullary fixation of extra-articular distal tibial fractures could avoid secondary replacement. METHODS: We prospectively included 167 patients receiving intramedullary nailing in treatment of distal tibial fractures. All these patients were encouraged to bear weight as tolerated postoperatively. One hundred and fifty-five patients who did not bear weight immediately after surgery were retrospectively included as historical control. RESULTS: The mean immediate lateral and anterior DTA were 88.9 +/- 3.9 and 85.2 +/- 3.5 degrees for historical control and 88.7 +/- 3.6 and 84.9 +/- 3.8 degrees for immediate weight bearing group (lateral DTA: P = 0.715; anterior DTA: P = 0.734). The mean final lateral and anterior DTA were 88.1 +/- 3.3 and 84.1 +/- 4.3 degrees for historical control and 87.9 +/- 5.0 and 84.5 +/- 5.1 degrees for the immediate weightbearing group (lateral DTA: P = 0.857; anterior DTA: P = 0.788). Strikingly, the immediate weightbearing resulted in accelerated healing (3.5 +/- 1.2 versus 4.9 +/- 1.3 months, P = 0.023) and decreased nonunion rate (2.4% versus 7.1%, P = 0.027). The rates of infection and soft-tissue necrosis were similar between the two groups. CONCLUSIONS: Immediate weightbearing after IMN fixation of extra-articular distal tibial fractures led to a similar change in alignment compared with our historical control without immediate weightbearing. Immediate weightbearing appears to be safe for most patients and might be able to accelerate fracture healing and decrease nonunion rate.