Effect of Early Protected Weight Bearing in Fracture Shaft of Femur: A Prospective Observational Study

Background: Femoral shaft fractures in young adults commonly result from high-energy trauma. Early protected weight bearing after stable intramedullary fixation may enhance callus formation, accelerate rehabilitation, and improve functional recovery. However, concerns regarding implant failure and nonunion persist. This study evaluates radiological union, functional outcomes, and complications following early protected weight bearing. Material and Methods: This prospective observational study was conducted over one year at a tertiary care teaching hospital in Mumbai. Thirty-five adult patients (aged 18-60 years) with closed or Gustilo-Anderson Type I open fractures of the femoral shaft, treated with closed/reduced interlocking intramedullary nailing, were included. Early protected weight bearing (partial with walker/crutches from day 3-7 post-op, progressing to full as tolerated by 4-6 weeks) was implemented under supervised physiotherapy. Exclusion criteria included polytrauma with unstable hemodynamics, pathological fractures, and severe comorbidities. Ethical approval was obtained from the institutional review board, and informed consent was taken. Radiological assessment (union via RUST score), functional evaluation (Klaus and Borner criteria), and complications were documented at regular intervals up to 12 months. Data were analyzed using SPSS version 25 with appropriate statistical tests (p<0.05 significant). Results: Mean age was 32.4 ± 8.7 years with male predominance (82.8%). Mean time to partial weight bearing was 5.2 days and full weight bearing 5.8 weeks. Radiological union was achieved in 91.4% by 16 weeks (mean 14.8 weeks). Excellent to good functional outcomes were seen in 88.6% per Klaus and Borner criteria. Complications included 2 cases of delayed union (5.7%), 1 superficial infection, and no implant failures or malunions requiring revision. Average hospital stay was 9.4 days. Patients returned to pre-injury activity levels faster compared to historical delayed protocols. Conclusion: Early protected weight bearing after interlocking nailing in femoral shaft fractures appears safe and effective, leading to satisfactory union rates, good functional recovery, and minimal complications in a Mumbai tertiary setup. It supports accelerated rehabilitation without compromising stability. Larger randomized trials are recommended.

Keywords: Femoral shaft fracture, early protected weight bearing, Intramedullary nailing, Functional outcome, Radiological union.