Outcomes of early versus delayed weight-bearing with intramedullary nailing of tibial shaft fractures: a systematic review and meta-analysis

Ameya Bhanushali, Joshua G. Kovoor, Brandon Stretton, James T. Kieu, Rebecca A. Bright, Joseph N. Hewitt, Christopher D. Ovenden, Aashray K. Gupta, Mohamed Z. Afzal, Suzanne Edwards, Ruurd L. Jaarsma, Christy Graff

Research output: Contribution to journalReview articlepeer-review

4 Citations (Scopus)
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Purpose: Early weight bearing (EWB) is often recommended after intramedullary nailing of tibial shaft fractures, however, the risks and benefits have not been critically evaluated in a systematic review or meta-analysis. Therefore, the aims of this study were to perform a systematic review and meta-analysis comparing EWB and delayed weight-bearing (DWB) after intramedullary nailing of tibial shaft fractures and assess the relationship between weight-bearing, fracture union and healing. Method: This review included studies comparing the effects of EWB, defined as weight-bearing before 6 weeks, and DWB on fracture union and healing. PubMed, Embase, CINAHL, and the Cochrane Library were searched from inception to 9 May 2021. Risk of bias was assessed using the Down’s and Black Checklist and Cochrane Risk of Bias Tool 2.0. Data were synthesised in a meta-analysis, as well as narrative and tabular synthesis. Results: Eight studies were included for data extraction and meta-analysis. The analysis produced mixed results and found a significant decrease in mean union time (−2.41 weeks, 95% confidence interval: −4.77, −0.05) with EWB and a significant Odd’s Ratio (OR) for complications with DWB (OR: 2.93, 95% CI: 1.40, 6.16). There was no significant difference in rates of delayed union, non-union, re-operation and malunion. Conclusion: The included studies were of moderate risk of bias and demonstrated shorter union time and fewer complications with EWB. However, current evidence is minimal and has significant limitations. The role of EWB in high-risk patients is yet to be examined. Further well-designed, randomised studies are required on the topic.

Original languageEnglish
Pages (from-to)3521-3527
Number of pages7
JournalEuropean Journal of Trauma and Emergency Surgery
Issue number5
Early online date3 Mar 2022
Publication statusPublished - Oct 2022


  • Early weight-bearing
  • Fracture union
  • Intramedullary nail
  • Tibial shaft
  • Trauma
  • Weight-bearing


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