Proefschrift

Chapter 5 66 The lack of evidence on aftercare protocols and on permissive weight bearing was the reason to design the PROMETHEUS protocol. In this study a description of a comprehensive protocol for permissive weight bearing has been presented as well as data on both time to full weight bearing and the number of complications in patients with surgically treated fractures of the pelvis and lower extremities. This pilot study is in our opinion quintessential for estimating the sample size in future prospective trials and for gaining insight into the heterogeneity that exists within and between different kind of fractures of the lower extremity with regard to time to full weight bearing and number of complications. However, limitations in our study include the retrospective nature of the study and, due to this retrospection, not taking into account surgeonoriented functional outcome scores (e.g. knee function) or generic patient satisfaction scores. Furthermore, no radiological controls have been done to investigate the alignment of the fractures and the fracture healing. Another limitation of the study is the lack of monitoring patient compliance. To mitigate the aforementioned limitations, and to find out whether a PWB protocol results in more favorable process outcomes and patient outcomes, further research is required to establish the added value in terms of effectiveness and costeffectiveness. To that aim, we have started a prospective cohort study with a control group, also including patient-reported outcome measures to cover the appropriate ICF levels.37 Conclusion The PROMETHEUS protocol is a patient tailored permissive weight bearing protocol. Given the low complication rate, the protocol might be beneficial to implement in the treatment of trauma patients with surgically treated articular or (peri)- or intra-articular fractures of the pelvis and lower extremities.

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