Proefschrift

Is the AO guideline for postoperative treatment of tibial plateau fractures still decisive? 25 Introduction The incidence of tibial plateau fractures is approximately 13.3 per 100,000 persons.1 The postoperative management of these surgically treated fractures in trauma patients is of the utmost importance for a full recovery of knee function and the patient’s participation in daily activities and work. Tibial plateau fractures are a cause of longterm disability and pain, and frequently lead to many weeks off work, with substantial economic effects. The standard aftercare treatment in surgically treated trauma patients with fractures of the tibial plateau is non-weight bearing or partial weight bearing.2 According to the AO Principles of Fracture Management, postoperative management of tibial plateau fractures consists of generally maintained on toe-touch weight bearing for 6–8 weeks. Exceptions are fractures caused by extremely high energy; these patients might need to adhere to toe-touch weight bearing for 10–12 weeks.3 However, there is currently no worldwide consensus among surgeons with regard to permissive weight bearing versus restricted weight bearing in surgical trauma patients with fractures of the tibial plateau.4 Permissive weight bearing might be early weight bearing, but this not the goal as such. In permissive weight bearing the patient dictates the progress in weight bearing together with the physiotherapist. Although biomechanical and animal studies suggest that early weight bearing is beneficial,5-7 there have been virtually no high-quality clinical studies comparing permissive weight bearing (PWB) with restricted weight bearing (RWB) after surgically treated tibial plateau fractures. The purpose of the present survey was to investigate the current state of postoperative practice among Dutch orthopaedic surgeons and trauma surgeons regarding patients with surgically treated tibial plateau fractures. The survey asked whether they adhered to the AO guideline and their own local guidelines and which criteria they used to decide when and at what level to start weight bearing after surgery. Materials and methods A web-based survey was developed by the authors and was distributed among Dutch orthopaedic surgeons and trauma surgeons, using online software (www.formdesk.nl). The survey was publicised at the Dutch trauma congress in 2013 and placed on the websites of the Dutch Trauma Society and the Dutch Orthopaedic Society. Together,

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