Weight-bearing recommendations after operative fracture treatment—fact or fiction? Gait results with and feasibility of a dynamic, continuous pedobarography insole

Braun, Benedikt J.; Veith, Nils T.; Rollmann, Mika F.; Orth, Marcel; Fritz, Tobias; Herath, Steven C.; Holstein, Joerg H.; Pohlemann, Tim

doi:10.1007/s00264-017-3481-7

Cited by 73 publications

(59 citation statements)

References 29 publications

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“…The study was limited by the fact that there was no blinding of patients, treating physicians or outcome assessors; however, it is unclear whether blinding is truly necessary in this pragmatic trial. A potential criticism also mentioned by Dehghan et al is the potential noncompliance of patients to their designated postoperative care regimen [4,9]. Patient noncompliance could lead to a higher rate of complications as described previously, although this was absent in the present study [20].…”

Section: Discussionmentioning

confidence: 47%

Weight-bearing or non-weight-bearing after surgical treatment of ankle fractures: a multicenter randomized controlled trial

Smeeing

Houwert

Briët

et al. 2018

Eur J Trauma Emerg Surg

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Purpose The goal of this study was to assess if unprotected weight-bearing as tolerated is superior to protected weightbearing and unprotected non-weight-bearing in terms of functional outcome and complications after surgical fixation of Lauge-Hansen supination external rotation stage 2-4 ankle fractures. Methods A multicentered randomized controlled trial was conducted in patients ranging from 18 to 65 years of age without severe comorbidities. Patients were randomized to unprotected non-weight-bearing, protected weight-bearing, and unprotected weight-bearing as tolerated. The primary endpoint of the study was the Olerud Molander Ankle Score (OMAS) 12 weeks after randomization. The secondary endpoints were health-related quality of life using the SF-36v2, time to return to work, time to return to sports, and the number of complications. Results The trial was terminated early as advised by the Data and Safety Monitoring Board after interim analysis. A total of 115 patients were randomized. The O'Brien-Fleming threshold for statistical significance for this interim analysis was 0.008 at 12 weeks. The OMAS was higher in the unprotected weight-bearing group after 6 weeks c(61.2 ± 19.0) compared to the protected weight-bearing (51.8 ± 20.4) and unprotected non-weight-bearing groups (45.8 ± 22.4) (p = 0.011). All other follow-up time points did not show significant differences between the groups. Unprotected weight-bearing showed a significant earlier return to work (p = 0.028) and earlier return to sports (p = 0.005). There were no differences in the quality of life scores or number of complications. Conclusions Unprotected weight-bearing and mobilization as tolerated as postoperative care regimen improved short-term functional outcomes and led to earlier return to work and sports, yet did not result in an increase of complications.

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Section: Discussionmentioning

confidence: 47%

Weight-bearing or non-weight-bearing after surgical treatment of ankle fractures: a multicenter randomized controlled trial

Smeeing

Houwert

Briët

et al. 2018

Eur J Trauma Emerg Surg

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“…For example, Braun et al used for their study a continuously measuring pedobarography insole to measure weightbearing in trauma patients with fractures of the lower extremities. The study showed that, despite physical therapy training, weight-bearing compliance to recommended limits was low (36). Overall, despite their willingness to comply, patients often do not adhere to the suggested restrictions on weight-bearing and increase their weight-bearing as fracture healing progresses.…”

Section: Resultsmentioning

confidence: 98%

“…While instructions for rehabilitation given to patients may be clear, patient compliance with a non-weightbearing or limited weight-bearing regime has been found to be poor (34,35). A number of studies found that patients had actually exceeded the prescribed amount of partial weight-bearing even though their self-reported compliance was high (35,36). For example, Braun et al used for their study a continuously measuring pedobarography insole to measure weightbearing in trauma patients with fractures of the lower extremities.…”

Section: Resultsmentioning

confidence: 99%

A protocol for permissive weight-bearing during allied health therapy in surgically treated fractures of the pelvis and lower extremities

Meys¹,

Kalmet²,

Sanduleanu³

et al. 2019

J Rehabil Med

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Aftercare in surgically treated trauma patients with fractures of the pelvis and lower extremities has remained largely unchanged during the past 60 years. To optimize rapid clinical recovery and the restoration of function and functionality, permissive weight-bearing has been designed as a new aftercare mobilization regime, within the upper boundary of the therapeutic bandwidth, yet safe enough to avoid overloading. The aim of the present paper is to describe a comprehensive protocol for permissive weight-bearing during allied health therapy and to report on both the time to full weight-bearing and the number of complications in patients with surgically treated fractures of the pelvis and lower extremities who undergo permissive weight-bearing. Objective: To optimize rapid clinical recovery and restoration of function and functionality, permissive weight-bearing has been designed as a new aftercare mobilization regimen, within the upper boundary of the therapeutic bandwidth, yet safe enough to avoid overloading. The aim of the present paper is to describe a comprehensive protocol for permissive weight-bearing during allied health therapy and to report on the time to full weight-bearing, as well as the number of complications, in patients with surgically treated fractures of the pelvis and lower extremities undergoing permissive weight-bearing. Patients and methods: This study included surgically treated trauma patients with (peri)-or intra-articular fractures of the pelvis and lower extremities. A standardized permissive weight-bearing protocol was used for all patients. Time to full weight-bearing and number of complications were recorded. Results: This study included 150 patients, 69% male, with a median age of 48 years (interquartile range (IQR) 33.0, 57.0). The median time to full weight bearing was 12.0 weeks (IQR 6.8, 19.2). The complication rate during rehabilitation was 10%. Conclusion: The permissive weight-bearing protocol, as described, might be beneficial and has potential to be implemented in trauma patients with surgically treated (peri)-or intra-articular fractures of the pelvis and lower extremities.

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“…The insole includes pressure and force sensor that measure the force applied at key bearing points under the foot. Such a selflearning adaptive weightbearing monitoring system also can deliver electrical, mechanical, and/or audio feedback to encourage a patient to load the optimal target weight, the patient is given continuous feedback for improving rehabilitation (25,26). Another recommendation for future research is the use of Virtual Stress Testing, which provide a non-invasive estimate of a healing bone through a CT scan and has the potential to provide a quantitative, objective measure to identify fractures who could safely handle bearing weight (27).…”

Section: Discussionmentioning

confidence: 99%

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

Lieshout

Moolenbroek

et al. 2018

Injury

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Weight-bearing recommendations after operative fracture treatment—fact or fiction? Gait results with and feasibility of a dynamic, continuous pedobarography insole

Cited by 73 publications

References 29 publications

Weight-bearing or non-weight-bearing after surgical treatment of ankle fractures: a multicenter randomized controlled trial

Weight-bearing or non-weight-bearing after surgical treatment of ankle fractures: a multicenter randomized controlled trial

A protocol for permissive weight-bearing during allied health therapy in surgically treated fractures of the pelvis and lower extremities

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

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