The physiological cost of restricted weight bearing

Westerman, Richard W.; Hull, P.; Hendry, Ross; Cooper, J.

doi:10.1016/j.injury.2007.11.007

Cited by 37 publications

(19 citation statements)

References 1 publication

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“…Early loading has the potential to aid in bone formation and fracture healing, provided that only moderate strain at the fracture site can be maintained. 8,9 Additionally, Westerman et al 30 showed that weight-bearing restriction significantly increases energy expenditure. Multiple n Feature Article studies have supported a benefit of early weight bearing, including faster return to work and improved patient quality of life and functional scores.…”

Section: Discussionmentioning

confidence: 99%

Early Versus Late Weight-Bearing Protocols for Surgically Managed Posterior Wall Acetabular Fractures

Heare¹,

Kramer²,

Salib³

et al. 2017

Orthopedics

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Despite overall improved outcomes with open reduction and internal fixation of acetabular fractures, posterior wall fractures show disproportionately poor results. The effect of weight bearing on outcomes of fracture management has been investigated in many lower extremity fractures, but evidence-based recommendations in posterior wall acetabular fractures are lacking. The authors systematically reviewed the current literature to determine if a difference in outcome exists between early and late postoperative weight-bearing protocols for surgically managed posterior wall acetabular fractures. PubMed and MEDLINE were searched for posterior wall acetabular fracture studies that included weight-bearing protocols and Merle d'Aubigné functional scores. Twelve studies were identified. Each study was classified as either early or late weight bearing. Early weight bearing was defined as full, unrestricted weight bearing at or before 12 weeks postoperatively. Late weight bearing was defined as restricted weight bearing for greater than 12 weeks postoperatively. The 2 categories were then compared by functional score using a 2-tailed t test and by complication rate using chi-square analysis. Six studies (152 fractures) were placed in the early weight-bearing category. Six studies (302 fractures) were placed in the late weight-bearing category. No significant difference in Merle d'Aubigné functional scores was found between the 2 groups. No difference was found regarding heterotopic ossification, avascular necrosis, superficial infections, total infections, or osteoarthritis. This systematic review found no difference in functional outcome scores or complication rates between early and late weight-bearing protocols for surgically treated posterior wall fractures. [Orthopedics. 2017: 40(4):e652-e657.].

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Section: Discussionmentioning

confidence: 99%

Early Versus Late Weight-Bearing Protocols for Surgically Managed Posterior Wall Acetabular Fractures

Heare¹,

Kramer²,

Salib³

et al. 2017

Orthopedics

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“…As the energy expenditure (i.e., cardiopulmonary demand) required for use of an assistive device is greater than the demand imposed during ambulation without a device, it is important for the physical therapist to examine the aerobic capacity of the individual. 6,7 Heart rate and rhythm, blood pressure, respiratory rate, and oxygen saturation (if applicable) must be assessed at rest, before the initiation of further tests and measures, as well as during and at the completion of aerobic activities (e.g., walking). …”

Section: Clinical Tipmentioning

confidence: 99%

Musculoskeletal System

Elrod¹

2014

Acute Care Handbook for Physical Therapists

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“…The surgical technique was not, though, formally described in these studies. Early weight bearing may be crucial for rehabilitation and good functional outcome and critical for the elderly since non-weight bearing is four times as demanding when walking [ 7 ]. A demand the older patients most often cannot honor and therefore need support.…”

Section: Introductionmentioning

confidence: 99%

Highly impacted bone allograft may allow immediate weight bearing in tibial plateau fractures: A case report

Hare

Brand

Bloch

2020

Trauma Case Reports

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Introduction Proximal tibial fractures are common with an incidence of 10.2/100.000. Those displaced and involving the articular surface will often require surgical treatment. However, no consensus exists on whether to allow the patient early weight bearing or not. We developed a technique using structural bone chips, highly impacted under the articular surface, to permit immediate weight bearing after surgery. Patient The patient was a 44-year old male who suffered a lateral tibial plateau fracture (AO type 41B2). Intervention We used an anterolateral approach with an S-shaped incision. A small window in the tibia was made using an awl, and the articular surface was reduced under radiographic imaging. The bone allograft was prepared by splitting the frozen femoral head in quarters and then taking large pieces of bone with a bone rongeur forceps avoiding the cartilage. The large pieces of bone were gathered in a small tray and thereafter compressed into the drill guide insert. The drill guide filled with bone graft was then inserted into the tibia window and directed in the appropriate position guided by radiography. Hereafter, the bone graft was impacted under the articular surface with force using the appropriate trocar and a hammer, and the fracture was finally reduced. Finally, the fracture was fixated utilizing an angular stable plate. Outcome The patient was followed up one year postoperatively and allowed immediate weight bearing after surgery. No subsequent articular collapse occurred. Discussion In this case, we present a proximal tibial fracture with articular depression, which was surgically treated with a highly impacted bone allograft of large pieces and a locking plate. The patient was allowed immediate weight bearing and no subsequent articular collapse occurred.

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The physiological cost of restricted weight bearing

Cited by 37 publications

References 1 publication

Early Versus Late Weight-Bearing Protocols for Surgically Managed Posterior Wall Acetabular Fractures

Early Versus Late Weight-Bearing Protocols for Surgically Managed Posterior Wall Acetabular Fractures

Musculoskeletal System

Highly impacted bone allograft may allow immediate weight bearing in tibial plateau fractures: A case report

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