Immediate weight bearing as tolerated versus delayed weight bearing following intramedullary fixation for geriatric intertrochanteric fractures: a post hoc analysis. BMC musculoskeletal disorders BACKGROUND:Early weight bearing is crucial for fracture healing after osteosynthesis for intertrochanteric fractures (ITFs). The optimal period to start weight bearing after surgery is still under debate. The aim of this study was to compare immediate weight bearing (IWB) as tolerated with delayed weight bearing (DWB) following intramedullary fixationin elderly ITF patients. METHODS:This post hoc analysis included patients aged ≥ 65 years with X-ray-confirmed ITFs who were admitted within 21 days after injury and who underwent intramedullary fixation surgery. The primary outcome was the EQ-5D score at 120 days after surgery. The secondary outcomes included the EQ-5D score at 30 days and 365 days after surgery, the complication rate and the mortality rate. RESULTS:Among 410 patients (190 IWB, 220 DWB), those in the IWB group had higher EQ-5D scores at 30 (P < 0.001) and 120 days (P = 0.002) but lower scores at 365 days (P = 0.012) than did those in the DWB group. There were no significant differences in the complication rates, reoperation rates, or one-year mortality rates between the groups. CONCLUSIONS:Compared with delayed weight bearing, immediate weight bearing improves early functional outcomes without increasing the complication or mortality rates in elderly ITF patients. 10.1186/s12891-024-08172-9

Return to sport following low-risk and high-risk bone stress injuries: a systematic review and meta-analysis. British journal of sports medicine OBJECTIVE:Bone stress injuries (BSIs) are classified in clinical practice as being at low- or high-risk for complication based on the injury location. However, this dichotomous approach has not been sufficiently validated. The purpose of this systematic review was to examine the prognostic role of injury location on return-to-sport (RTS) and treatment complications after BSI of the lower extremity and pelvis. DESIGN:Systematic review and meta-analysis. DATA SOURCES:PubMed, Web of Science, Cochrane CENTRAL and Google Scholar databases were searched from database inception to December 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES:Peer-reviewed studies that reported site-specific RTS of BSIs in athletes. RESULTS:Seventy-six studies reporting on 2974 BSIs were included. Sixteen studies compared multiple injury sites, and most of these studies (n=11) described the anatomical site of injury as being prognostic for RTS or the rate of treatment complication. Pooled data revealed the longest time to RTS for BSIs of the tarsal navicular (127 days; 95% CI 102 to 151 days) and femoral neck (107 days; 95% CI 79 to 135 days) and shortest duration of time for BSIs of the posteromedial tibial shaft (44 days, 95% CI 27 to 61 days) and fibula (56 days; 95% CI 13 to 100 days). Overall, more than 90% of athletes successfully returned to sport. Treatment complication rate was highest in BSIs of the femoral neck, tarsal navicular, anterior tibial shaft and fifth metatarsal; and lowest in the fibula, pubic bone and posteromedial tibial shaft. CONCLUSION:This systematic review supports that the anatomical site of BSIs influences RTS timelines and the risk of complication. BSIs of the femoral neck, anterior tibial shaft and tarsal navicular are associated with increased rates of complications and more challenging RTS. PROSPERO REGISTRATION NUMBER:CRD42021232351. 10.1136/bjsports-2022-106328

Physical preparation and return to sport of the football player with a tibia-fibula fracture: applying the 'control-chaos continuum'. Taberner Matt,van Dyk Nicol,Allen Tom,Richter Chris,Howarth Carl,Scott Simon,Cohen Daniel D BMJ open sport & exercise medicine Contact in elite football can result in severe injury such as traumatic fracture. Limited information exists regarding the rehabilitation and return to sport (RTS) of these injuries especially in elite football. We outline the RTS of an elite English Premier League footballer following a tibia-fibula fracture including gym-based physical preparation and the use of 'control-chaos continuum' as a framework for on-pitch sport-specific conditioning, development of technical skills while returning the player to pre-injury chronic running loads considering the qualitative nature of movement in competition. Strength and power diagnostics were used to back up clinical reasoning and decision-making throughout rehabilitation and the RTS process. The player returned to full team training after 7.5 months, completed 90 min match-play after 9 months and remains injury-free 11 months post-RTS. 10.1136/bmjsem-2019-000639