Proefschrift

Is the AO guideline for postoperative treatment of tibial plateau fractures still decisive? 31 The period of delayed weight bearing was reported to depend, inter alia, on the fracture type, certainty or uncertainty about fixation quality and additional traumata. To date, we have not been able to identify studies providing methodologically sound evidence as to critical factors that may assist in the decision to start weight bearing earlier or later. However, many studies have shown a trend towards favouring earlier weight bearing. Longer-term outcomes have also been described in the literature, with no negative effects of early weight bearing being reported.8-13 It is important to note that this study did not intend to determine the optimal aftercare for a given tibial plateau fracture, but was designed to disclose the current practice regarding tibial plateau fracture surgery aftercare and the factors on which orthopaedic surgeons and trauma surgeons found their decisions. This study clearly demonstrates that there is as yet no consensus about the aftercare of tibial plateau fractures. Furthermore, there is no evidence to restrict patients in bearing weight for 10-12 weeks as suggested by the AO guideline. Our findings show that at least in the Netherlands, the AO guideline is not decisive. In addition, we found large variations in post-operative rehabilitation treatment. It should be kept in mind that another complicating factor could be lack of patient compliance with prescribed rehabilitation aftercare.14,15 A number of studies reported that patients often exceeded the prescribed level of partial weight bearing, even when self-reported compliance was high.16 Thus, despite the expressed willingness to comply, patients often do not follow the restrictions on weight bearing and increase their weight bearing as fracture healing progresses. Together with the finding that there is no consensus as to what the definition of “100% weight bearing” is and how to build up weight in a protocolled way, our study revealed a large diversity in practical weight bearing usage among surgeons. This makes it even more difficult to achieve a good interpretation of the aftercare and offer customized advice to patients regarding the optimal aftercare in terms of weight bearing during the rehabilitation. There are a few important limitations of this study. The study is limited by the response rate. The survey didn’t describe the different types of fractures and assumptions regarding the energy of trauma. Furthermore, it is important to note that this study does not attempt to describe what the correct aftercare treatment is in tibial plateau fractures, but rather 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. In summary, the outcome of this survey shows that there is no clear consensus about optimal postoperative treatment of patients with a tibial plateau fracture, which may result in suboptimal rehabilitation aftercare. This leaves open the question what is the optimal rehabilitation treatment in surgically treated

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