Proefschrift

Chapter 9 128 the treatment of trauma patients with surgically treated articular or peri- and/or intra-articular fractures of the pelvis and lower extremities. 5. Permissive weight bearing after surgically treated tibial plateau fractures is safe and is related to a significantly reduced time to full weight bearing with no significant differences in patient-reported quality of life and pain or complication rates. 6. In a prospective, comparative, multicenter study, we found that permissive weight bearing in surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities is effective (less time to weight bearing) and is associated with a significant reduction in time to full weight bearing and significantly better outcomes in terms of ADL and quality of life compared to the restricted weight bearing regime, with comparable complication rates among both regimes. 7. Permissive weight bearing is more cost-effective compared to the restricted weight bearing regimen. Moreover, the permissive weight bearing group showed more improvement in ADL and quality of life compared to the restricted weight bearing group. Looking at the incremental economic analyses, permissive in comparison to restricted weight bearing was less expensive and yielded more effects in terms of ADL performance. Future perspectives Despite the addition of a substantial body of work in this thesis in the evidence based approach to aftercare protocols in patients with peri- and intra-articular fractures of the lower extremities, we believe important work still will need to be carried out in order to improve future PWB protocols. Permissive weight bearing requires high-level evidence from randomized controlled-trials per individual type of peri- and intra-articular fracture of the lower extremities, as physiological differences in weight bearing might need to be taken into account in future PWB protocols. Certainly the safety of PWB protocols in all patients needs to be addressed, for instance by taking into account negatively influencing clinical factors such as osteoporosis, diabetes mellitus, arthrtis etc. Furthermore, in this thesis, surgeon-oriented functional outcome scores (e.g. the function of a knee or ankle joint) were not taken into account, information which might improve awareness and agreement from the surgeon community with PWB aftercare protocols.

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