Proefschrift

Patient-reported quality of life and pain after PWB in surgically treated tibial plateau fractures 73 Introduction The incidence of patients with tibial plateau fractures is approximately 13.3 per 100,000.1 Protocols for postoperative management of tibial plateau fractures were formulated about 60 years ago and suggest non- or partial weight bearing.2 A survey about the adherence of current protocols showed that almost 90% of the surgeons do not follow these protocols standardly regarding the weight bearing aftercare for tibial plateau fractures.3 In addition, patient’s compliance to a non- or partial weight bearing regimen is found to be poor and highly depending on the age of the patient.ϰ͕ϱ Elderly patients seem to be unable to maintain weight-bearing restrictions.6 Thus, patients are likely to start weight bearing in an earlier phase than prescribed in current protocols. The postoperative management of these surgically treated tibial plateau fractures in trauma patients is also very important regarding the functional outcome. The average overall postoperative complication rate in tibial plateau fractures, combining implant failures, secondary dislocation, non-union and infections into a composite end ƉŽŝŶƚ͕ ŝƐ ĂƌŽƵŶĚ ϰ-Ϯϳ% according to literature.ϳ-ϭϰ The standard aftercare treatment in surgically treated trauma patients with fractures of the tibial plateau features is non- or partial weight bearing.15 According to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) principles of fracture management, postoperative management of tibial plateau fractures generally consists of toe-touch weight bearing for 6–8 weeks. As to fractures caused by extremely high energy impact, these patients may need to adhere to toe-touch weight bearing regimen for 10–12 weeks.2 There is currently no consensus among surgeons worldwide with regard to early weight bearing (i.e. permissive weight bearing) versus restricted weight bearing in surgically treated trauma patients with fractures of the tibial plateau.16 Biomechanical and animal studies indicate that early weight bearing is beneficial,ϭϳ-19 but high-quality clinical studies comparing permissive weight bearing (PWB) versus restricted weight bearing (RWB) after surgically treated tibial plateau fractures are scarce. The aim of the present study was to inventory potential differences in 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.

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