Proefschrift

Effectiveness of PWB in surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities 85 Introduction The recommendations for aftercare in surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities are still more or less the same as they were during the last 60 years, without any source of evidence being given for the advice of restricted weight bearing.1 In view of this lack of evidence, many orthopedic and trauma surgeons tend to advise conservatively with regard to postoperative management and hold on to the prevailing dogmas, i.e. non-weight bearing or restricted weight bearing.2 The current recommendations regarding postoperative management in surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities is either non-weight bearing or restricted weight bearing for 6-12 weeks, followed by partial weight bearing with a 25% increase in weight every week.1,3 There is no consensus from the surgeons in the current postoperative management.4 Moreover, almost 90% of the surgeons deviate from the current postoperative management protocols because of e.g. type of fracture, (un-) certainty of fixation, clinical experience or gut feeling.4 Furthermore, while instructions on rehabilitation provided to patients may be clear, patients’ compliance with a nonweight bearing or restricted weight bearing regimen is poor, so neither surgeons nor patients follow the instructions regarding the postoperative management regimen.5,6 The postoperative management of surgically treated peri- and intra-articular fractures of the lower extremities is very important in view of the impact on the patient’s functional outcome. Recent literature has reported composite postoperative complication rates of up to 37%, with an average of 10–20% for patients with lower extremity fractures.7-11 In addition, several studies indicate that the postoperative management, i.e. early or permissive weight bearing, increases the postoperative complications rates.3,4 Several biomechanical, animal and clinical studies have found early or permissive weight bearing to be beneficial.2,3,12-15 However, very few clinical studies are available that compared permissive weight bearing (PWB) with restricted weight bearing (RWB) in surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities. Furthermore, despite the generally accepted value of the use of patientspecific outcome measures, no data is available offering insights into patients’ selfperceived outcome levels (e.g. regarding activities of daily living (ADL), quality of life or pain) in either PWB or RWB.

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