Perhaps surgical techniques have changed and some are allowed but a good proportion are not allowed to weightbear. May I know the reasons or indications to keep a patient non-weightbearing? Noted a previous discussion on load bearing and sharing differences a few years back. Noted for IM Nailing, which is load sharing, patients are allowed to weight-bear early. Noted also that a dynamic hip screw is load bearing but weight bearing is allowed since stability is achieved. Thanks!
As you have already mentioned, plate acts as a load bearing Implant and maximum stresses are transmitted through it while bone takes minimum of the stresses. If patient bears weight there are chances of Implant failure through the weak links between bone screw composite. So it's better to keep patient non weight bearing till the bone is ready to transfer the maximum stress after union. This is more true for communited or multifragmentary fractures fixed by bridge plating.
I agree that plates are load bearing implant as compared to intramedullary nailing which are load sharing. But if the fixation is good, one can start weight bearing( partial ) at the earliest.
It is a bespoke scenario but we tend to let them weight bear. There are multiple factors to consider. Internal fixation is not a new science. The first half
of the twentieth century has provided us with ample documentation of the results of unstable internal fixation. Surgery has frequently proved to be the worst
form of treatment. It destroyed the soft tissue hinges, interfered with biological factors such as the blood supply and the periosteum, and was never sufficiently strong or stable to permit active mobilization of the limbs with partial loading. Supplemental external plaster fixation was often necessary. The emphasis
was on bone healing and not on soft tissue rehabilitation. Healing became evident when callus appeared. Unfortunately, unstable internal fixation was unpredictable
and uncertain, and it frequently resulted in delayed union, nonunion, or deformity. When union did occur, instead of signifying the end of treatment it merely signaled the beginning of a prolonged phase of rehabilitation designed to regain motion in the soft tissue envelope and in the stiff joints. The ravages
of this prolonged nonfunctional form of treatment were such that open reduction and internal fixation were looked upon as the last resort in the treatment of a fracture.
Neutralization plates or protection plates are used to protect the primary lag screw fixation. They conduct part or all of the forces from one fragment to
the other. In this way they protect the fracture fixation from the forces of bending shear and rotation
In metaphyseal areas the cortex is very thin, and if subjected to load it can fail. Such failures result in deformity and axial overload of the joint. Therefore, internal fixation in metaphyseal areas requires protection with plates that support the underlying cortex. These are referred to as buttress plates. Buttressing
may also be achieved with external fixation.
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