• Blaise Wardle, Joseph T Lynch, Thomas Staniforth, Thomas Ward, and Paul Smith.
• Trauma and Orthopaedic Research Unit, Yamba Drive, Canberra, Australian Capital Territory, 2605, Australia. blaise.wardle@gmail.com.
• Eur J Trauma Emerg Surg. 2024 May 22.

BackgroundDemographics of patients who sustain geriatric distal femoral fractures (DFF) match those of patients with neck-of-femur fractures but have limited evidence with which to support post-operative weightbearing protocols.PurposeThis systematic review sought to identify any difference in outcomes for elderly patients with DFF who were allowed early versus delayed weightbearing postoperatively.MethodsDATA SOURCES: PubMed, Medline, Embase and The Cochrane Library, reference lists of retrieved articles.Study SelectionEnglish language papers published between January 2010 and February 2023 with AO-OTA type 33A, B and C femoral fractures as well as Lewis and Rorabeck Type I and II periprosthetic DFF surgically treated with either a lateral locking plate or retrograde intramedullary nail and an average patient age of ≥ 60 years.Data ExtractionStudies were assessed for inclusion by two authors and quality was assessed using the MINORS tool.Data SynthesisSixteen studies were included, Meta-analysis of non-union, malunion, infection, delayed union and implant complications was performed using Microsoft Excel and the MetaXL extension. The data on return to mobility were presented in narrative form. The analyses demonstrated no difference between the early and delayed weightbearing groups.ConclusionsThere are no significant differences in complication rates between early versus delayed weightbearing after surgery for DFF in an elderly population. The study results are limited by high heterogeneity and low-quality studies. High quality, prospective studies are needed to determine the ideal postoperative weightbearing protocol.Level Of EvidenceLevel III, Systematic Review and Meta-analysis of Level III studies. International Prospective Register of Systematic Reviews registration-Prospero CRD42022371460.© 2024. The Author(s).

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