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Published in: BMC Surgery 1/2018

Open Access 01-12-2018 | Study protocol

Permissive weight bearing in trauma patients with fracture of the lower extremities: prospective multicenter comparative cohort study

Authors: Pishtiwan H. S. Kalmet, Guido Meys, Yvette Y. v. Horn, Silvia M. A. A. Evers, Henk A. M. Seelen, Paul Hustinx, Heinrich Janzing, Alexander vd Veen, Coen Jaspars, Jan Bernard Sintenie, Taco J. Blokhuis, Martijn Poeze, Peter R. G. Brink

Published in: BMC Surgery | Issue 1/2018

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Abstract

Background

The standard aftercare treatment in surgically treated trauma patients with fractures around or in a joint, known as (peri)- or intra-articular fractures of the lower extremities, is either non-weight bearing or partial weight bearing. We have developed an early permissive weight bearing post-surgery rehabilitation protocol in surgically treated patients with fractures of the lower extremities. In this proposal we want to compare our early permissive weight bearing protocol to the existing current non-weight bearing guidelines in a prospective comparative cohort study.

Methods/design

The study is a prospective multicenter comparative cohort study in which two rehabilitation aftercare treatments will be contrasted, i.e. permissive weight bearing and non-weight bearing according to the AO-guideline. The study population consists of patients with a surgically treated fracture of the pelvis/acetabulum or a surgically treated (peri)- or intra-articular fracture of the lower extremities. The inclusion period is 12 months. The duration of follow up is 6 months, with measurements taken at baseline, 2,6,12 and 26 weeks post-surgery.
Primary outcome measure: ADL with Lower Extremity Functional Scale. Outcome variables for compliance, as measured with an insole pressure measurement system, encompass peak load and step duration.

Discussion

This study will investigate the (cost-) effectiveness of a permissive weight bearing aftercare protocol. The results will provide evidence whether a permissive weight bearing protocol is more effective than the current non-weight bearing protocol.

Trial registration

The study is registered in the Dutch Trial Register (NTR6077). Date of registration: 01–09-2016.
Literature
1.
go back to reference Ruedi T. AO principles of fracture management. New York: Thieme; 2007. Ruedi T. AO principles of fracture management. New York: Thieme; 2007.
2.
go back to reference Muller ME. Manual of internal fixation techniques. Published by: Berlin, Springer; 1977. Muller ME. Manual of internal fixation techniques. Published by: Berlin, Springer; 1977.
3.
go back to reference Haller J. Weight bearing after a periarticular fracture. What is the evidence? Orthop Clin N Am. 2013;44:509–19.CrossRef Haller J. Weight bearing after a periarticular fracture. What is the evidence? Orthop Clin N Am. 2013;44:509–19.CrossRef
4.
go back to reference van der Vusse M. Is the AO guideline for postoperative treatment of tibial plateau fractures still decisive? A survey among orthopaedic surgeons and trauma surgeons in the Netherlands. Arch Orthop Trauma Surg. 2017;137:1071–5.CrossRefPubMedPubMedCentral van der Vusse M. Is the AO guideline for postoperative treatment of tibial plateau fractures still decisive? A survey among orthopaedic surgeons and trauma surgeons in the Netherlands. Arch Orthop Trauma Surg. 2017;137:1071–5.CrossRefPubMedPubMedCentral
5.
go back to reference Hustedt J. Is it possible to train patients to limit weight bearing on a lower extremity? Orthopedics. 2012;35:e31–7.PubMed Hustedt J. Is it possible to train patients to limit weight bearing on a lower extremity? Orthopedics. 2012;35:e31–7.PubMed
6.
go back to reference Warren C. Training procedures and biofeedback methods to achieve controlled partial weight bearing: an assessment. Arch Phys Med Rehabil. 1975;56:449–55.PubMed Warren C. Training procedures and biofeedback methods to achieve controlled partial weight bearing: an assessment. Arch Phys Med Rehabil. 1975;56:449–55.PubMed
7.
go back to reference Choo K. Postoperative complications after repair of tibial plateau fractures. J Knee Surg. 2014;27:11–20.CrossRefPubMed Choo K. Postoperative complications after repair of tibial plateau fractures. J Knee Surg. 2014;27:11–20.CrossRefPubMed
9.
go back to reference Yu X. Postoperative complications after closed calcaneus fracture treated by open reduction and internal fixation: a review. J Int Med Res. 2013;42:14–25. Yu X. Postoperative complications after closed calcaneus fracture treated by open reduction and internal fixation: a review. J Int Med Res. 2013;42:14–25.
10.
go back to reference Koval K. Functional outcomes and mortality vary among different types of hip fractures: a function of patient characteristics. Clin Orthop Relat Res. 2004;425:64–71.CrossRef Koval K. Functional outcomes and mortality vary among different types of hip fractures: a function of patient characteristics. Clin Orthop Relat Res. 2004;425:64–71.CrossRef
11.
go back to reference Dong-Hyun L. Comparison of early versus delayed Weightbearing outcomes after microfracture for small to midsized Osteochondral lesions of the talus. Am J Sports Med. 2012;40(9):2023–8.CrossRef Dong-Hyun L. Comparison of early versus delayed Weightbearing outcomes after microfracture for small to midsized Osteochondral lesions of the talus. Am J Sports Med. 2012;40(9):2023–8.CrossRef
12.
go back to reference Jason J. Talar neck fractures: a systematic review of the literature. J Foot Ankle Surg. 2013;52(1):56–61.CrossRef Jason J. Talar neck fractures: a systematic review of the literature. J Foot Ankle Surg. 2013;52(1):56–61.CrossRef
13.
go back to reference Lasanianos N. Early mobilization after uncomplicated medial subtalar dislocation provides successful functional results. J Orthop Traumatol. 2011;12(1):37–43.CrossRefPubMedPubMedCentral Lasanianos N. Early mobilization after uncomplicated medial subtalar dislocation provides successful functional results. J Orthop Traumatol. 2011;12(1):37–43.CrossRefPubMedPubMedCentral
14.
go back to reference Mario CK. Early mobilization in bilateral talar fractures. Foot Ankle Online J. 2014;7(2):9. Mario CK. Early mobilization in bilateral talar fractures. Foot Ankle Online J. 2014;7(2):9.
15.
go back to reference Schwabe P. Complications after osteosynthetic treatment of acetabular fractures. Orthopade. 2014;43(1):24–34.CrossRefPubMed Schwabe P. Complications after osteosynthetic treatment of acetabular fractures. Orthopade. 2014;43(1):24–34.CrossRefPubMed
16.
go back to reference Papakostidis C. Pelvic ring disruptions: treatment modalities and analysis of outcomes. Int Orthop. 2009;33(2):329–38.CrossRefPubMed Papakostidis C. Pelvic ring disruptions: treatment modalities and analysis of outcomes. Int Orthop. 2009;33(2):329–38.CrossRefPubMed
18.
go back to reference Repo JP. Treatment of compound tibia fracture with microvascular latissimus dorsi flap and the Ilizarov technique: a cross-sectional study of long-term outcomes. J Plast Reconstr Aesthet Surg. 2015;69:524–32.CrossRef Repo JP. Treatment of compound tibia fracture with microvascular latissimus dorsi flap and the Ilizarov technique: a cross-sectional study of long-term outcomes. J Plast Reconstr Aesthet Surg. 2015;69:524–32.CrossRef
19.
go back to reference Garner MR. Elective removal of implants after open reduction and internal fixation of Tibial plateau fractures improves clinical outcomes. Arch Orthop Trauma Surg. 2015;135:1491–6.CrossRefPubMed Garner MR. Elective removal of implants after open reduction and internal fixation of Tibial plateau fractures improves clinical outcomes. Arch Orthop Trauma Surg. 2015;135:1491–6.CrossRefPubMed
20.
go back to reference Binkley J. The lower extremity functional scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic rehabilitation research network. Phys Ther. 1999;79(4):371–83.PubMed Binkley J. The lower extremity functional scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic rehabilitation research network. Phys Ther. 1999;79(4):371–83.PubMed
21.
go back to reference Fugl-Meyer A. The poststroke hemiplegic patient, I: a method for evaluation of physical performance. Scand J Rehabil Med. 1975;7:13–31.PubMed Fugl-Meyer A. The poststroke hemiplegic patient, I: a method for evaluation of physical performance. Scand J Rehabil Med. 1975;7:13–31.PubMed
22.
go back to reference Unal G. A psychometric comparison of health related quality of life measures in chronic liver diseases. J Clin Epidemiol. 2001;54:587–96.CrossRefPubMed Unal G. A psychometric comparison of health related quality of life measures in chronic liver diseases. J Clin Epidemiol. 2001;54:587–96.CrossRefPubMed
23.
go back to reference Versteegh M. Dutch tariff for the five-level version of EQ-5D. J Value Health. 2016;19(4):343–52.CrossRef Versteegh M. Dutch tariff for the five-level version of EQ-5D. J Value Health. 2016;19(4):343–52.CrossRef
24.
go back to reference Hurkmans H. 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. 2007;88:200–6.CrossRefPubMed Hurkmans H. 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. 2007;88:200–6.CrossRefPubMed
25.
go back to reference Hurkmans H. Effectiveness of audio feedback for partial weightbearing in and outside the hospital: a randomized controlled trial. Arch Phys Med Rehabil. 2012;93:565–70.CrossRefPubMed Hurkmans H. Effectiveness of audio feedback for partial weightbearing in and outside the hospital: a randomized controlled trial. Arch Phys Med Rehabil. 2012;93:565–70.CrossRefPubMed
26.
go back to reference Winstein C. Learing a partial-weight-bearing skill: effectiveness of two forms of feedback. Phys Ther. 1996;76:985–93.CrossRefPubMed Winstein C. Learing a partial-weight-bearing skill: effectiveness of two forms of feedback. Phys Ther. 1996;76:985–93.CrossRefPubMed
27.
go back to reference Raaben M. Technical aspects and validation of a new biofeedback system for measuring lower limb loading in the dynamic situation. Sensors (Basel). 2017;22(17). Raaben M. Technical aspects and validation of a new biofeedback system for measuring lower limb loading in the dynamic situation. Sensors (Basel). 2017;22(17).
28.
go back to reference Care Institute the Netherlands. Guideline for conducting economic evaluations in health care. [Zorginstituut Nederland. Richtlijn voor het uitvoeren van economische evaluaties in de gezondheidszorg]. Diemen: ZiNL; 2016. Care Institute the Netherlands. Guideline for conducting economic evaluations in health care. [Zorginstituut Nederland. Richtlijn voor het uitvoeren van economische evaluaties in de gezondheidszorg]. Diemen: ZiNL; 2016.
29.
go back to reference Thorn J. Resource-use measurement based on patient recall: issues and challenges for economic evaluation. Appl Health Econ Health Policy. 2013;11(3):155–61.CrossRefPubMed Thorn J. Resource-use measurement based on patient recall: issues and challenges for economic evaluation. Appl Health Econ Health Policy. 2013;11(3):155–61.CrossRefPubMed
Metadata
Title
Permissive weight bearing in trauma patients with fracture of the lower extremities: prospective multicenter comparative cohort study
Authors
Pishtiwan H. S. Kalmet
Guido Meys
Yvette Y. v. Horn
Silvia M. A. A. Evers
Henk A. M. Seelen
Paul Hustinx
Heinrich Janzing
Alexander vd Veen
Coen Jaspars
Jan Bernard Sintenie
Taco J. Blokhuis
Martijn Poeze
Peter R. G. Brink
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2018
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-018-0341-3

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