Proefschrift

General discussion 127 continuously measuring pedobarography insole (Moticon) to measure the weight bearing in trauma patient with fractures of the lower extremities. The study showed that, despite physical therapy training, weight-bearing compliance to recommended limits was low and was apparently well tolerated.25 That means that the aftercare could be accomplished in a more timely fashion within a safe way when using a permissive weight bearing protocol. Finally in this thesis, in a prospective study, the cost-effectiveness in surgically treated trauma patients with peri- and/or intra-articular fractures of the lower extremities was estimated. In the Netherlands, annually, the incidence of peri- and/or intra-articular fractures of the lower extremities is more than 25,000 patients.26 This study found that the PWB protocol is €457.51 cheaper compared to the usual current RWB protocol. Annually, this may result in a saving of at least €11,437,750 in the Netherlands. So, the permissive weight bearing protocol is more cost-effective and will contribute to a cheaper health care. In our opinion, we, as surgeons, should be brave and start as a community to let the patients mobilize earlier according to their toleration level, as the future requires a holistic view of our patient population. Overall conclusion This thesis has shed more light on the efficacy and (cost)-effectiveness of a permissive weight bearing protocol in surgically treated trauma patients with peri- and intraarticular fractures of the lower extremities. In light of the positive findings of PWB in comparison to RWB, it contests the paradigm behind the current guidelines, which have remained unchanged for well over 60 years. In line with our research objectives from chapter 2 we would like to summarize and conclude that: 1. To optimize recovery with a minimal complication rate, it is recommended to use a treatment intensity that is near to the upper boundary of the therapeutic bandwidth, yet safe enough to avoid overloading, and that such treatment is guided by the permissive weight bearing protocol. 2. Consensus about the weight bearing aftercare for tibial plateau fractures is limited. A large majority of surgeons do not follow the AO guideline or their own local protocol. More transparent criteria and predictors are needed to design optimal weight-bearing regimes for the aftercare of tibial plateau fractures. 3. The economic burden in monetary terms and the effect on QoL of patients with peri- and/or intra-articular fractures of the lower extremities during the first 6 months follow-up has been presented. 4. The permissive weight bearing protocol is a patient-tailored and safe protocol. Given the low complication rate, the protocol may be beneficial to implement in

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