Optimal care for the management of older people non-weight bearing after lower limb fracture: a consensus study

Abstract

Background Older people who are non-weight-bearing after a lower limb fracture are at risk of poor outcomes but there are no clinical guidelines for this group of patients. Given the paucity of the research evidence base, we conducted a consensus exercise to ascertain expert opinion about the management of this group. Methods A three-round e-Delphi technique was planned to use the online JISC survey tool with a multidisciplinary panel of health professionals. Panellists were invited by email via professional organisations and UK NHS Trusts. The initial statements for this study were prepared by the authors based upon the findings of their scoping review. Consensus required >/= 70% agreement with statements. Results Only 2 survey rounds were required. Ninety panellists, representing seven clinical disciplines, reached consensus for 24 statements about general issues (osteoporosis detection and management, falls risk reduction and nutrition) and specific non-weight bearing issues (such as the need for activity to be promoted during this period). Conclusions These findings can be used in the generation of a clinical guideline for this group of patients.

Consensus on managing open ankle fractures in the frail patient

“…However, there is a reluctance to allow full weightbearing for periarticular fractures, including tibial plateau, plafond, and ankle fractures. There have been efforts to try and form a consensus opinion to create guidelines for weightbearing patients; 13 however, there are often not implemented in clinical practice.…”

“…10 Compared to fit patients, the frail patient is at risk of increased mortality rates following multiple surgeries, 11 significant sarcopaenia following just seven days bed rest, 12 and restricted rehabilitation caused increased bed sores, hospital-acquired infections, and veno-thromboembolic events. 13 This review and report followed a modified Delphi method involving a panel of experts and delegates to discuss and identify key clinical decisions and organizational problems in the management of open ankle fractures in the frail. Furthermore, it aimed to identify common problems and concerns that exist in the surgical community in managing these patients and potentially reduce the morbidity and mortality.…”

“…10 Compared to fit patients, the frail patient is at risk of increased mortality rates following multiple surgeries, 11 significant sarcopaenia following just seven days bed rest, 12 and restricted rehabilitation caused increased bed sores, hospital-acquired infections, and veno-thromboembolic events. 13…”

Rehabilitation nursing after lower limb fracture: Preventing deep vein thrombosis and enhancing quality of life

“…Lower limb fractures are a prevalent clinical condition that significantly impacts patients’ daily functioning and occupational performance. [1] The deceleration of venous blood flow in these patients ultimately contributes to an elevated susceptibility to deep venous thrombosis (DVT). [2,3] The occurrence rate of lower limb fractures in China is approximately 3.6%, based on incomplete data, with the majority of DVT affecting the lower limbs and being rare in the upper limbs.…”