Journal of Foot and Ankle Surgery - 2026-04-08 - Journal Article
Effect of Postoperative Weight-Bearing Timing on Functional and Radiological Outcomes in Distal Tibial Metaphyseal Fractures: A Retrospective Cohort Study.
Bulut M, Soy F
Topics
Key Takeaway
In 58 patients treated with MIPPO for distal tibial metaphyseal fractures, time to weight-bearing was not an independent predictor of 12-month AOFAS scores; fracture complexity (AO 43-A3) and higher BMI were the dominant outcome predictors.
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Summary
This study asked whether postoperative weight-bearing timing affects functional and radiological outcomes in AO 43-A1 through A3 distal tibial metaphyseal fractures treated with MIPPO plating. Multivariable linear regression on 58 patients found no independent association between time to weight-bearing and 12-month AOFAS scores. AO 43-A3 fractures had significantly worse 12-month AOFAS scores and delayed return to work compared to A1/A2, while MDTA, ADTA, and time to union did not differ across groups.
Key Limitation
The retrospective design with heterogeneous, non-protocolized weight-bearing timing introduces selection bias, as surgeons likely delayed weight-bearing in more complex or osteoporotic cases, confounding the primary exposure-outcome relationship despite multivariable adjustment.
Original Abstract
BACKGROUND
The optimal timing of postoperative weight bearing after distal tibial metaphyseal fractures remains controversial, particularly in patients treated with plate fixation.
PURPOSE
To evaluate the effect of postoperative weight-bearing timing on functional and radiological outcomes in distal tibial metaphyseal fractures treated with minimally invasive percutaneous plate osteosynthesis (MIPPO).
STUDY DESIGN
Retrospective cohort study.
METHODS
This retrospective cohort study included adult patients who underwent MIPPO plating for distal tibial metaphyseal fractures between 2019 and 2024. Fractures were classified as AO 43-A1, AO 43-A2, or AO 43-A3. Weight-bearing progression was documented from electronic records. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score at 6 and 12 months. Radiological outcomes included medial distal tibial angle (MDTA), anterior distal tibial angle (ADTA), time to union, and return to work. Multivariable linear regression identified predictors of 12-month AOFAS scores.
RESULTS
Fifty-eight patients were included. AOFAS scores at 6 months were comparable among AO subgroups, whereas a significant difference was observed at 12 months, with AO 43-A3 fractures demonstrating poorer outcomes. Time to union did not differ among groups, whereas return to work was delayed in AO 43-A3 fractures. In multivariable analysis, time to weight bearing was not independently associated with 12-month AOFAS scores, while fracture complexity and higher BMI were independent predictors of poorer outcome.
CONCLUSIONS
In distal tibial metaphyseal fractures treated with MIPPO plating, postoperative weight-bearing timing was not independently associated with functional outcomes. Long-term recovery was primarily influenced by fracture complexity and patient-related factors.