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

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

doi:10.1186/s12893-018-0341-3

Cited by 18 publications

(14 citation statements)

References 23 publications

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“…Recent studies have shown that the increase in load‐bearing by the fracture ideally takes place in parallel with fracture healing 39 Normal weight bearing stimulates bone healing, whereas activity above normal neither accelerates nor impairs this process. The function of muscles and joints around a fracture site seems to be an important stimulus to the bone‐healing‐process 40 …”

Section: Discussionmentioning

confidence: 99%

In‐vivo comparison of the Ni‐free steel X13CrMnMoN18–14‐3 and titanium alloy implants in rabbit femora – A promising steel for orthopedic surgery

et al. 2020

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A variety of metallic biomaterials is used for fracture fixation. Allergic reactions towards nickel‐containing steels urge the need for alternatives. The present study investigated the suitability of the nickel‐free stainless steel P2000 in comparison to titanium alloy implants for bone surgical applications in a rabbit femora defect model. Thirty‐six rabbits received two different cylindrical implants press‐fit inserted into the distal femoral metaphysis. At day 0, 28, and 56, implant ingrowth was monitored by radiography; implant stability was assessed by pull‐out torque measurements while bone‐to‐implant contact (BIC) was determined histomorphometrically. Radiography revealed comparable implant ingrowth after 1 and 2 months for both implant materials. The pull‐out force of P2000 tended to be higher than that for titanium at day 28 (p = .076) but the values were comparable at day 56 (p = .905). At day 56, implant fixation was significantly increased compared to the day of surgery for both, P2000 (p = .030) and for titanium alloy (p = .026). Microscopic examination revealed that both implant types appeared to be well integrated and firmly anchored in the bone. BIC ratio of titanium alloy tended to be higher at day 28 (p = .079) but they did not differ significantly at day 56 (p = .711). In the present rabbit femora defect model, the nickel‐free stainless steel P2000 provides primary stability and osseointegration comparable to that of titanium alloy implants.

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Section: Discussionmentioning

confidence: 99%

In‐vivo comparison of the Ni‐free steel X13CrMnMoN18–14‐3 and titanium alloy implants in rabbit femora – A promising steel for orthopedic surgery

et al. 2020

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“…To mitigate the aforementioned limitations, and to determine whether a PWB protocol results in more favourable process outcomes and patient outcomes, requires further research to establish the added value in terms of effectiveness and cost-effectiveness. To that aim, we have started a prospective cohort study with a control group, also including patient-reported outcome measures to cover the appropriate ICF levels (37).…”

Section: Discussionmentioning

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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“…Another limitation of the study is the lack of monitoring patient compliance. To mitigate these limitations, we have started a prospective cohort study in patients with fractures of the lower extremities [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Patient-reported quality of life and pain after permissive weight bearing in surgically treated trauma patients with tibial plateau fractures: a retrospective cohort study

Kalmet

Horn

Sanduleanu

et al. 2018

Arch Orthop Trauma Surg

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IntroductionA Dutch survey among orthopedic surgeons and trauma surgeons showed that almost 90% of the surgeons do not follow protocols regarding the weight bearing aftercare for tibial plateau fractures. Clinical studies comparing permissive weight bearing (PWB) versus restricted weight bearing (RWB) after surgically treated tibial plateau fractures are not available. The aim of this study was to inventory potential differences in quality of life and pain, and number of complications in patients with surgically treated tibial plateau fractures who followed a PWB regime, relative to those that followed a RWB regime.Materials and methodsThis retrospective cohort study included surgically treated trauma patients with tibial plateau fractures, who underwent rehabilitation according to PWB or RWB between 2005 and 2015. Data such as demographics, patient-reported quality of life and pain, and patient outcome were collected.ResultsThis cohort study included 91 patients with a tibial plateau fracture (31 and 60 patients in the PWB and RWB groups respectively). No significant between-group differences in either age or gender were found. However, a significant difference in fracture type was found between groups, (p = 0.04). No significant differences were found in either patient-reported SF-12 or VAS scores between the PWB group and RWB group. Time to full weight bearing was significantly shorter in the PWB than in the RWB group, i.e., 14.7 versus 20.7 weeks, (p = 0.02). No significant differences were found regarding postoperative complications between the PWB and the RWB groups, i.e., 6.5% versus 10.0%, respectively.ConclusionPWB after surgically treated tibial plateau fractures is safe and is related to a significantly reduced time to full weight bearing with no significant differences in patient-reported quality of life and pain or complication rates.

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

Cited by 18 publications

References 23 publications

In‐vivo comparison of the Ni‐free steel X13CrMnMoN18–14‐3 and titanium alloy implants in rabbit femora – A promising steel for orthopedic surgery

In‐vivo comparison of the Ni‐free steel X13CrMnMoN18–14‐3 and titanium alloy implants in rabbit femora – A promising steel for orthopedic surgery

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

Patient-reported quality of life and pain after permissive weight bearing in surgically treated trauma patients with tibial plateau fractures: a retrospective cohort study

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