Proefschrift

Outline of thesis 19 This thesis describes the current state of practice among surgeons and cost-of-illness regarding non- or restricted weight bearing (RWB) (current guidelines), a comprehensive protocol for permissive weight bearing (PWB) and the (cost-) effectiveness of permissive weight bearing versus non- or restricted weight bearing. The permissive weight bearing concept has been introduced in chapter 1, while the non- or restricted weight bearing protocol is the current guideline in surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities. However, as found in chapter 1, there are no studies done investigating the use of the permissive weight bearing protocol in surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities. The permissive weight bearing protocol might be beneficial and has potential to be implemented in surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities. Therefore, the purposes of the thesis were to describe the current state of practice among surgeons and the economic impact regarding non- or restricted weight bearing, a comprehensive protocol for permissive weight bearing and the (cost-) effectiveness of permissive weight bearing versus non- or restricted weight bearing. The hypothesis of this thesis is that the permissive weight bearing protocol in surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities is more effective and cost-effective compared to the non- or restricted weight bearing protocol. Furthermore, the rate of complications (e.g. failure of osteosynthesis, secondary displacement of fracture parts, non-union, infections) is equal or lower in patients who are treated according to the permissive weight bearing protocol compared to patients treated according the non- or restricted weight bearing protocol. The following research objectives were formulated: 1. To investigate the current state of practice among orthopaedic surgeons and trauma surgeons in choosing the criteria and the time period of restricted weight bearing after surgically treated tibial plateau fractures. 2. To determine the economic impact of the (after)care in surgically treated trauma patients with peri- and/or intra-articular fractures of the lower extremities 3. To describe a comprehensive protocol for permissive weight bearing during allied health therapy and to report on both the time to full weight bearing and the number of complications in patients with surgically treated fractures of the pelvis and lower extremities who undergo permissive weight bearing. 4. To compare quality of life and pain, and number of complications in patients with surgically treated tibial plateau fractures who followed a permissive weight bearing regime, relative to those that followed a restricted weight bearing regime. 5. To determine the effectiveness of the permissive weight bearing protocol compared with respect to early recovery (during first 6 months) of functional

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