Proefschrift

Chapter 3 30 operated less than 5 times, N=16 (14.4%) between 5-10 times and N=4 (3.6%) more than 10 times. Fifty-three (47.7%) of the respondents were conservative in the aftercare of tibial plateau fractures and N=58 (52.3%) were progressive in the aftercare. Figure 3.5 How do surgeons advise their patients about increasing weight bearing following a graded protocol? A: Graded increase over time in a fixed number of weeks, expressed in kilogram or percentage of body weight B: Graded increase over a fixed number of weeks, expressed as as much weight bearing as tolerated by the patient C: Permissive weight bearing, which means surgeons let patients and therapists decide how to build up the weight bearing as tolerated D: Other. Discussion This survey is an attempt to obtain up-to-date information on the time period between surgical treatment of tibial plateau fractures and the start of rehabilitation involving weight bearing. The AO guideline for postoperative management of tibial plateau fractures was formulated about 50 years ago and suggests restricted weight bearing for approximately 12 weeks.3 It is generally assumed that orthopaedic surgeons and trauma surgeons follow the AO guideline, advocating restricted weight bearing during aftercare for the patients. Interestingly, the present study shows that a large proportion of orthopaedic surgeons and trauma surgeons in the Netherlands recommended starting weight bearing earlier than 12 weeks. In practice, the vast majority of the responding surgeons deviated from their own institutional guidelines, based on clinical experience and gut feeling, thus deviating from the AO guideline.

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