Priority 11 from the Complex Fractures PSP

UNCERTAINTY: When is it safe to start weight-bearing and joint movement after a complex fracture?  (JLA PSP Priority 11)
Overall ranking 11
JLA question ID 0105/11
Explanatory note For some types of fracture surgeons may decide to restrict movement and weight-bearing after surgical fixation to reduced a perceived risk of impairment of healing. However, this may result in longer patient stays in hospital , dependence on care services, and muscle loss leading to poor patient outcome.  

NG37 and 39 mention weight-bearing in terms of an outcome from studies they have reviewed. However, these guidelines offer no specific advice.

The WAX Weightbearing in Ankle Fractures trial will report in 2022 but will not entirely answer this question in the context of complex fractures.

No other relevant trial evidence Cochrane/PUBMED since 2015. 

NICE Guideline 37 Fractures (complex): assessment and management

NICE Guideline 39 Major trauma: assessment and initial management

WAX Weightbearing in Ankle Fractures Randomised Controlled Trial (ongoing)

Health Research Classification System category Injuries and accidents
Extra information provided by this PSP
Original uncertainty examples Early weight bearing and movement in lower limb fractures ~  Effectiveness of ORIF on allowing people to weightbear - technically patients should be able to weight bear following ORIF but this in not standard ~ Weight bearing to fracture of the leg where a joint involved + the bone is broken into multiple pieces ~ When should rehab start? ~  difficulties with mobilisation
Submitted by 16 x Surgeon/Doctor, 7 x Physio, 3 x Knows a patient, 2 x Healthcare Professional (unspecified), 3 x patient  
PSP information
PSP unique ID 0105
PSP name Complex Fractures
Total number of uncertainties identified by this PSP. 58  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 8th June 2021