Proefschrift

Chapter 1 12 literature has reported composite postoperative complication rates of up to 37% in non-weight bearing.26-35 To optimize recovery with a minimal complication rate, it might be useful to use a treatment that is near the upper boundary of the therapeutic bandwidth, yet safe enough to avoid overloading, essentially the goals of the permissive weight bearing protocol. Permissive weight bearing Permissive weight bearing is a comprehensive protocol during rehabilitation and evaluation of surgically treated lower extremity fractures. This should enable a more systematic monitoring and guidance of the aftercare, based on patients’ individual characteristics, characteristics of the surgically treated fractures, verifiable evidencebased criteria related to healing processes of surgically treated fractures, therapeutic milestones that may be set, indicators of progress that can be identified and evidence for the prevention of complications. In an early aftercare treatment regimen for an individual patient with a surgically treated fracture of a lower extremity, rehabilitation specialists or therapists should address and/or systematically monitor several issues: a) Which realistic treatment outcomes may be aimed for, given the patient’s specific fracture? b) How fast is the specific fracture consolidating in this patient? c) How fast does weight bearing capacity develop during bone healing, as this is essential in determining the pace at which training intensity may be safely increased? d) What kind of complications may be expected during the recovery process, which must be carefully monitored in order to take effective early counteractive measures? Conclusion One of the main reasons for developing a systematic and comprehensive protocol has been the fact that, despite major improvements in surgical treatment and osteosynthesis materials, rehabilitation after surgical treatment of fractures has remained almost unchanged over the last six decades. The permissive weight bearing protocol has been developed in close cooperation between rehabilitation specialists, physical therapists and (orthopedic) trauma surgeons. It should serve as a general reference framework and a starting point for a discussion of the systematic optimization of the rehabilitation in patients with surgically treated fractures of the lower extremities, rather than as a library of predefined standard solutions

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