The effect of time to post-operative weightbearing on functional and clinical outcomes in adults with a displaced intra-articular calcaneal fracture; A systematic review and pooled analysis

Boer, Annette S. de; Lieshout, Esther M.M. Van; Moolenbroek, Gerson Van; Hartog, Dennis den; Verhofstad, Michael H.J.

doi:10.1016/j.injury.2018.02.021

Cited by 12 publications

(8 citation statements)

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“…De Boer et al found that early weight bearing regimens did not negatively affect functional outcome after treatment for displaced intra-articular calcaneal fractures. 64 Previously, Smeeing et al showed that early weight bearing tended to accelerate return to work and daily activities compared with late weight bearing, after internal fixation of ankle fractures. 65 Eliasson et al evaluated tendon elongation, mechanical properties, and functional outcomes during the first 12 months after operative treatment of acute Achilles tendon ruptures.…”

Section: Discussionmentioning

confidence: 99%

Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis

Ochen

Beks

Heijl

et al. 2019

BMJ

235

223

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ObjectivesTo compare re-rupture rate, complication rate, and functional outcome after operative versus nonoperative treatment of Achilles tendon ruptures; to compare re-rupture rate after early and late full weight bearing; to evaluate re-rupture rate after functional rehabilitation with early range of motion; and to compare effect estimates from randomised controlled trials and observational studies.DesignSystematic review and meta-analysis.Data sourcesPubMed/Medline, Embase, CENTRAL, and CINAHL databases were last searched on 25 April 2018 for studies comparing operative versus nonoperative treatment of Achilles tendon ruptures.Study selection criteriaRandomised controlled trials and observational studies reporting on comparison of operative versus nonoperative treatment of acute Achilles tendon ruptures.Data extractionData extraction was performed independently in pairs, by four reviewers, with the use of a predefined data extraction file. Outcomes were pooled using random effects models and presented as risk difference, risk ratio, or mean difference, with 95% confidence interval.Results29 studies were included—10 randomised controlled trials and 19 observational studies. The 10 trials included 944 (6%) patients, and the 19 observational studies included 14 918 (94%) patients. A significant reduction in re-ruptures was seen after operative treatment (2.3%) compared with nonoperative treatment (3.9%) (risk difference 1.6%; risk ratio 0.43, 95% confidence interval 0.31 to 0.60; P<0.001; I2=22%). Operative treatment resulted in a significantly higher complication rate than nonoperative treatment (4.9% v 1.6%; risk difference 3.3%; risk ratio 2.76, 1.84 to 4.13; P<0.001; I2=45%). The main difference in complication rate was attributable to the incidence of infection (2.8%) in the operative group. A similar reduction in re-rupture rate in favour of operative treatment was seen after both early and late full weight bearing. No significant difference in re-rupture rate was seen between operative and nonoperative treatment in studies that used accelerated functional rehabilitation with early range of motion (risk ratio 0.60, 0.26 to 1.37; P=0.23; I2=0%). No difference in effect estimates was seen between randomised controlled trials and observational studies.ConclusionsThis meta-analysis shows that operative treatment of Achilles tendon ruptures reduces the risk of re-rupture compared with nonoperative treatment. However, re-rupture rates are low and differences between treatment groups are small (risk difference 1.6%). Operative treatment results in a higher risk of other complications (risk difference 3.3%). The final decision on the management of acute Achilles tendon ruptures should be based on patient specific factors and shared decision making. This review emphasises the potential benefits of adding high quality observational studies in meta-analyses for the evaluation of objective outcome measures after surgical treatment.

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Section: Discussionmentioning

confidence: 99%

Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis

Ochen

Beks

Heijl

et al. 2019

BMJ

235

223

View full text Add to dashboard Cite

show abstract

“…Furthermore, Tian et al and de Boer et al agreed with the statement that there is not any influence between an early weight bearing and the occurence of complications [ 21 , 22 ].…”

Section: Discussionmentioning

confidence: 95%

Analysis of partial weight bearing after surgical treatment in patients with injuries of the lower extremity

Eickhoff

Cintean

Fiedler

et al. 2020

Arch Orthop Trauma Surg

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Introduction After surgical treatment of injuries of the lower extremity, partial weight bearing is often suggested until soft tissue consolidation. It is doubtful, if this recommendation can be implemented, even in the case that a patient is performing partial weight bearing with a physical therapist. Consequently the question remains, if patients are able to implement partial weight bearing after surgery and which factors favor incompliance. Materials and methods 49 patients, who underwent surgical treatment after injuries of the lower extremity, were equipped with electronic shoe insoles on both sides. Different weight bearing instructions were given depending on the type of injury and surgery (full weight bearing vs. 20 kg weight bearing vs. non-weight bearing). Besides loading, other factors like age, gender, weight and physical activity were evaluated. Statistical analysis was performed using Chi-square and Fisher's exact test with significance set at a p value < 0.05. Results 25 of the 40 patients, who had to perform non-or partial weight bearing, were not able to follow postoperative instructions (compliance rate 37.5%). The average loading of the whole collective was 32.6 kg (4.8-109.2 kg). The specification of loading had no statistically significant influence on real loading (p-value 0.39). Elderly patients were less able to follow instructions than younger patients (36 vs 30.2 kg). Physically active compared to non-active patients overloaded their injured extremity (37.8 vs 28.7 kg). Patients with a high body mass index (BMI) encountered more difficulties to perform partial weight bearing than lightweight patients (36.9 vs 25.1 kg). Conclusions Most patients were not able to follow loading limitation, even a few days after surgery and even if the patients were trained by a physiotherapist. Excessive weight bearing-related complications should be evaluated.

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“…More and more studies show that permissive weightbearing reduces time to FWB, return to work, and thus lowers the socioeconomic impact, while negative effects on patients reported quality of life, pain or complication rates are rarely reported [ 30 ]. A recent review states multiple positive effects in early weightbearing while aftercare from operatively treated DIACFs [ 31 ]. Although many studies suggested the benefits of early weightbearing, yet there currently is no prospective literature available that compares operatively treated DIACFs followed by 8 to 12 weeks of restrictive weightbearing with permissive weightbearing, let alone subdivided for different fracture types or approaches.…”

Section: Discussionmentioning

confidence: 99%

Are the non-weight bearing guidelines for the after treatment of calcaneal fractures still decisive? A Dutch survey among orthopaedic and trauma surgeons

Verstappen

Driessen

Kalmet

et al. 2023

Eur J Orthop Surg Traumatol

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Purpose The current rehabilitation for patients with surgically treated displaced intra-articular calcaneal fractures (DIACFs) consists of non-weightbearing for 8–12 weeks. The purpose of the present survey was to investigate the current pre-, peri- and post-operative practices among Dutch foot and ankle surgeons. Moreover, it aims to analyze whether surgeons comply to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) guidelines and which decision criteria were used in the determination of the start of weightbearing. Methods A survey was distributed among Dutch trauma and orthopaedic surgeons to determine the most common practices in postoperative weightbearing in patients with DIACFs. Results 75 surgeons responded to the survey. 33% of the respondents adhered to the AO guidelines. 4% of the respondents strictly followed non-weightbearing guidelines, while 96% interpret the AO guidelines or their local protocol freely, in any frequency. When respondents tended to deviate from the AO guidelines or local protocol, a good patients’ compliance to therapy was expected. 83% of the respondents started weightbearing on the fracture, based on reported patient complaints. 87% of the respondents did not see any relation between early weightbearing and the occurrence of complications, including loosening of osteosynthesis materials. Conclusion This study demonstrates that there is limited consensus on the rehabilitation for DIACFs. Moreover, it shows that most surgeons are inclined to interpret the current (AO) guideline or their own local protocol freely. New guidelines, supported with well-founded literature, could help surgeons in a more appropriate daily practice in weightbearing for the rehabilitation of calcaneal fractures.

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The effect of time to post-operative weightbearing on functional and clinical outcomes in adults with a displaced intra-articular calcaneal fracture; A systematic review and pooled analysis

Cited by 12 publications

References 89 publications

Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis

Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis

Analysis of partial weight bearing after surgical treatment in patients with injuries of the lower extremity

Are the non-weight bearing guidelines for the after treatment of calcaneal fractures still decisive? A Dutch survey among orthopaedic and trauma surgeons

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