# Immediate full weightbearing with additive cerclage improves early mobility after tibial shaft spiral fractures

## TL;DR

Using additive cerclage allows patients with tibial shaft spiral fractures to walk immediately after surgery, improving early mobility and quality of life.

## Contribution

This study demonstrates that additive cerclage enables immediate full weightbearing, leading to faster recovery compared to standard partial weightbearing.

## Key findings

- By week 3, 35% of patients with additive cerclage walked unassisted compared to 6.25% with standard care.
- At week 6, 75% of cerclage-treated patients walked without crutches versus 31.25% in the standard group.
- Gait speed and quality of life were significantly better in the cerclage group with no increased complications.

## Abstract

In recent years, the trend in orthopedic and trauma surgery has shifted towards earlier mobilization with reduced weightbearing restrictions to enhance patient recovery. Tibial-shaft-spiral-fractures pose a challenge for early mobilization. This study examines the use of additive cerclages, which allow for immediate full-weightbearing, and compares it to the standard-of-care (SOC) treatment with partial-weightbearing. The primary aim was to evaluate mobility, return-to-daily-activities, and safety outcomes. This prospective multicenter study included 36 patients with tibial-shaft-spiral-fractures. Group1 (n = 20) received an additive cerclage and was permitted immediate full weightbearing-as-tolerated, while Group2 (n = 16) followed SOC with 20 kg partial weightbearing for 6 weeks. Gait analysis was performed at 1,3,6, and 12-weeks, as well as 6-months post-surgery, using the loadsol® force-measuring device. Patient-reported outcomes, including pain levels, quality of life (EQ-5D), and return to daily activities, were assessed at these intervals. The results showed that immediate weightbearing as tolerated led to significantly faster mobilization. By week-3, 35% (7 of 20) of patients in Group1 were walking unassisted compared to 6.25% (1 of 16) in Group 2 (p = 0.04). By week 6, 75% (15 of 20) of patients in Group1 were walking without crutches, compared to 31.25% (5 of 16) in Group2 (p = 0.002). Gait speed and mobility were significantly improved in the cerclage group throughout the early postoperative period, with quality of life scores also higher during the early postoperative phase (gait speed week 3 2.57 ± 0.49 km/h vs. 2.16 ± 0.70 km/h, p = 0.032; EQ-5D week 1 3.59 ± 0.85 vs. 3.05 ± 0.56, p = 0.017). No significant differences in complications were observed between the groups. The use of additive cerclages for tibial-shaft-spiral-fractures is a safe and effective method that allows for immediate full-weightbearing, resulting in earlier mobilization and improved short-term quality of life.

Trail registration number: DRKS00035464 (www.drks.de), Date of registration: 17/12/2024.

The online version contains supplementary material available at 10.1038/s41598-025-24566-8.