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Published in: Archives of Orthopaedic and Trauma Surgery 8/2017

Open Access 01-08-2017 | Trauma Surgery

Is the AO guideline for postoperative treatment of tibial plateau fractures still decisive? A survey among orthopaedic surgeons and trauma surgeons in the Netherlands

Authors: M. van der Vusse, P. H. S. Kalmet, C. H. G. Bastiaenen, Y. Y. van Horn, P. R. G. Brink, H. A. M. Seelen

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 8/2017

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Abstract

Introduction

The standard aftercare treatment (according to the AO guideline) for surgically treated trauma patients with fractures of the tibial plateau is non-weight bearing or partial weight bearing for 10–12 weeks. The purpose of this study was to investigate the current state of practice among orthopaedic surgeons and trauma surgeons in choosing the criteria and the time period of restricted weight bearing after surgically treated tibial plateau fractures.

Materials and methods

A web-based survey was distributed among members of the Dutch Trauma Society and Dutch Orthopaedic Society to identify the most commonly applied protocols in terms of the post-operative initiation and level of weight bearing in patients with tibial plateau fractures.

Results

One hundred and eleven surgeons responded to the survey. 72.1% of the respondents recommended starting weight bearing earlier than the 12 weeks recommended by the AO guideline; 11.7% recommended starting weight bearing immediately, 4.5% after 2 weeks and 55.9% after 6 weeks. Moreover, 88.7% of the respondents reported deviating from their own local protocol. There is little consensus about the definition of 100% weight bearing and how to build up weight bearing over time.

Conclusion

This study demonstrates that consensus about the weight bearing aftercare for tibial plateau fractures are limited. A large majority of surgeons do not follow the AO guideline or their own local protocol. More transparent criteria and predictors are needed to design optimal weight-bearing regimes for the aftercare of tibial plateau fractures.
Literature
1.
go back to reference Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37(8):6917CrossRef Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37(8):6917CrossRef
2.
go back to reference Haller JM, Kubiak EN (2013) Weight bearing after a periarticular fracture: what is the evidence? Orthop Clin North Am 44(4):509–519CrossRefPubMed Haller JM, Kubiak EN (2013) Weight bearing after a periarticular fracture: what is the evidence? Orthop Clin North Am 44(4):509–519CrossRefPubMed
3.
go back to reference Rüedi TP, Buckley RE, Moran CG (2007) AO principles of fracture management, 2nd edn. Thieme, New York, p 832 Rüedi TP, Buckley RE, Moran CG (2007) AO principles of fracture management, 2nd edn. Thieme, New York, p 832
4.
go back to reference Kubiak EN, Beebe MJ, North K et al (2013) Early weight bearing after lower extremity fractures in adults. J Am Acad Orthop Surg 21(12):727–738PubMed Kubiak EN, Beebe MJ, North K et al (2013) Early weight bearing after lower extremity fractures in adults. J Am Acad Orthop Surg 21(12):727–738PubMed
5.
go back to reference Bailon-Plaza A, van der Meulen MC (2003) Beneficial effects of moderate, early loading and adverse effects of delayed or excessive loading on bone healing. J Biomech 36(8):1069–1077CrossRefPubMed Bailon-Plaza A, van der Meulen MC (2003) Beneficial effects of moderate, early loading and adverse effects of delayed or excessive loading on bone healing. J Biomech 36(8):1069–1077CrossRefPubMed
6.
go back to reference Claes LE, Heigele CA, Neidlinger-Wilke C et al (1998) Effects of mechanical factors on the fracture healing process. Clin Orthop Relat Res (355 Suppl):S132–147 Claes LE, Heigele CA, Neidlinger-Wilke C et al (1998) Effects of mechanical factors on the fracture healing process. Clin Orthop Relat Res (355 Suppl):S132–147
7.
go back to reference Gardner MJ, van der Meulen MC, Demetrakopoulos D et al (2006) In vivo cyclic axial compression affects bone healing in the mouse tibia. J Orthop Res 24(8):1679–1686CrossRefPubMedPubMedCentral Gardner MJ, van der Meulen MC, Demetrakopoulos D et al (2006) In vivo cyclic axial compression affects bone healing in the mouse tibia. J Orthop Res 24(8):1679–1686CrossRefPubMedPubMedCentral
8.
go back to reference Kutzner I, Heinlein B, Graichen F et al (2010) Loading of the knee joint during activities of daily living measured in vivo in five subjects. J Biomech 43(11):2164–2173CrossRefPubMed Kutzner I, Heinlein B, Graichen F et al (2010) Loading of the knee joint during activities of daily living measured in vivo in five subjects. J Biomech 43(11):2164–2173CrossRefPubMed
9.
go back to reference Brown TD, Anderson DD, Nepola JV et al (1988) Contact stress aberrations following imprecise reduction of simple tibial plateau fractures. J Orthop Res 6:851–862CrossRefPubMed Brown TD, Anderson DD, Nepola JV et al (1988) Contact stress aberrations following imprecise reduction of simple tibial plateau fractures. J Orthop Res 6:851–862CrossRefPubMed
10.
go back to reference Solomon LB, Callary SA, Stevenson AW et al (2011) Weight-bearing-induced displacement and migration over time of fracture fragments following split depression fractures of the lateral tibial plateau: a case series with radiostereometric analysis. J Bone Jt Surg Br 93(6):817–823CrossRef Solomon LB, Callary SA, Stevenson AW et al (2011) Weight-bearing-induced displacement and migration over time of fracture fragments following split depression fractures of the lateral tibial plateau: a case series with radiostereometric analysis. J Bone Jt Surg Br 93(6):817–823CrossRef
11.
go back to reference Canadian Orthopaedic Trauma S (2006) Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Results of a multicenter, prospective, randomized clinical trial. J Bone Jt Surg Am 88(12):2613–2623CrossRef Canadian Orthopaedic Trauma S (2006) Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Results of a multicenter, prospective, randomized clinical trial. J Bone Jt Surg Am 88(12):2613–2623CrossRef
12.
go back to reference Westerman RW, Hull P, Hendry RG, Cooper J (2008) The physiological cost of restricted weight bearing. Injury 39(7):725–727CrossRefPubMed Westerman RW, Hull P, Hendry RG, Cooper J (2008) The physiological cost of restricted weight bearing. Injury 39(7):725–727CrossRefPubMed
13.
go back to reference de Morree JJ (2009) Dynamics of human connective tissue. Bohn Stafleu van Loghum, Houten de Morree JJ (2009) Dynamics of human connective tissue. Bohn Stafleu van Loghum, Houten
14.
go back to reference Hurkmans HL, Bussmann JB, Selles RW et al (2007) The difference between actual and prescribed weight bearing of total hip patients with a trochanteric osteotomy: long-term vertical force measurements inside and outside the hospital. Arch Phys Med Rehabil 88:200–206CrossRefPubMed Hurkmans HL, Bussmann JB, Selles RW et al (2007) The difference between actual and prescribed weight bearing of total hip patients with a trochanteric osteotomy: long-term vertical force measurements inside and outside the hospital. Arch Phys Med Rehabil 88:200–206CrossRefPubMed
15.
go back to reference Hustedt JW, Blizzard DJ, Baumgaertner MR et al (2012) Is it possible to train patients to limit weight bearing on a lower extremity? Orthopedics. 35:e31–e37PubMed Hustedt JW, Blizzard DJ, Baumgaertner MR et al (2012) Is it possible to train patients to limit weight bearing on a lower extremity? Orthopedics. 35:e31–e37PubMed
16.
go back to reference Warren CG, Lehmann JF (1975) Training procedures and biofeedback methods to achieve controlled partial weight bearing: an assessment. Arch Phys Med Rehabil 56(10):449–455PubMed Warren CG, Lehmann JF (1975) Training procedures and biofeedback methods to achieve controlled partial weight bearing: an assessment. Arch Phys Med Rehabil 56(10):449–455PubMed
17.
go back to reference Segal D, Mallik AR, Wetzler MJ et al (1993) Early weight bearing of lateral tibial plateau fractures. Clin Orthop Relat Res 294:232–237 Segal D, Mallik AR, Wetzler MJ et al (1993) Early weight bearing of lateral tibial plateau fractures. Clin Orthop Relat Res 294:232–237
Metadata
Title
Is the AO guideline for postoperative treatment of tibial plateau fractures still decisive? A survey among orthopaedic surgeons and trauma surgeons in the Netherlands
Authors
M. van der Vusse
P. H. S. Kalmet
C. H. G. Bastiaenen
Y. Y. van Horn
P. R. G. Brink
H. A. M. Seelen
Publication date
01-08-2017
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 8/2017
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-017-2718-7

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