Permissive weight bearing after fixation of displaced acetabular fractures: A case series study

Jan Biert, Bas Frietman, Vincent Stirler, Erik Hermans, Indy Smits, Niek Koenders
Purpose:

The aim of this study is to examine functional outcomes and safety outcomes of permissive weight bearing after operatively treated displaced acetabular fractures.

Methods:

This single center case series study included the first ten patients who underwent surgery in a European level one trauma center. Patients with relevant concomitant injuries (e.g., fractures that might impede rehabilitation) were excluded. Functional outcome was scored using the Hip disability and Osteoarthritis Outcome Score and the modified Merle d’Aubigné Postel score. A Low Dose CT was performed for detecting safety outcomes such as secondary fracture displacement.

Results:

Ten patients were included. The average preoperative displacement was 12mm. The median Hip disability and Osteoarthritis Outcome Score was 99.7 (interquartile range (IQR): 87.5-100) preoperative, 18 (IQR: 15-37.5) on day one-three, 38.9 (IQR: 35-53.8) in week one, 42.2 (IQR: 36.4-54.4) in week three, 54.1 (IQR: 32.5-64.4) in week six, and 65 (IQR: 43.8-79.4) in week twelve. The median modified Merle d’Aubigné and Postel score was 11.5 (IQR 9-13.5) in week one, 14 (IQR 11-15.5) in week three, 14 (IQR 11.5-15.5) in week fix, and 17 (IQR 14.5-17.5) in week twelve. Secondary displacement occurred in three out of ten patients. Remarkably, these three patients had a fracture impacting the dome of the acetabular joint.

Conclusion(s):

To our knowledge, this study represents the first investigation to specifically implement permissive weightbearing mobilization for patients with displaced acetabular fractures treated with open reduction and internal fixation (ORIF). The functional outcomes observed at twelve weeks are promising, and permissive weightbearing appears to be sufficiently safe for patients who do not exhibit impaction or involvement of the dome following surgical fixation of a displaced acetabular fracture.

Implications:

The adoption of permissive weight-bearing as a postoperative policy seems safe. Physical therapists may improve early functional recovery and functional performance by using permissive weightbearing in individuals recovering after surgery for a displaced acetabular fracture.

Funding acknowledgements:
Not applicable
Keywords:
Permissive weight bearing
Functional and safety outcomes
Acetabular fractures
Primary topic:
Disability and rehabilitation
Second topic:
Musculoskeletal
Third topic:
Orthopaedics
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
This study was approved by the Ethics Committee of the Radboud University Medical Center
Provide the ethics approval number:
Registration number NL56814.091.16
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
Yes

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