Weight-bearing Recommendations Research Articles

Surgical management and weight-bearing recommendations for geriatric distal femur fractures.

To investigate current practices among orthopaedic trauma surgeons in treating geriatric distal femur fractures and evaluate current postoperative weight-bearing recommendations. A 26-question survey was emailed to Major Extremity Trauma Research Consortium surgeon members to characterize current practice with different fixation methods for distal femur fractures and the surgeon-directed postoperative weight-bearing recommendations for each approach. Surveys were completed by 123 orthopaedic trauma surgeons with a response rate of 37% (123/332). Retrograde intramedullary nailing (IMN) was commonly performed by 88% of surgeons, and lateral locked plate was commonly performed by 74% of surgeons. Retrograde IMN with a lateral plate was commonly performed by 51% of surgeons. Dual femoral plating was commonly performed by 18% of surgeons and sometimes performed by 39% of surgeons. Surgeons were significantly more likely to allow immediate postoperative weight-bearing for retrograde IMN (P < 0.001), retrograde IMN with lateral plate (P < 0.001), and dual plate (P < 0.001) as compared with locked lateral plate. Most surgeons (79%) would be interested in participating in a randomized controlled trial (RCT) investigating single implant versus dual implant for distal femur fractures and believe that a trial incorporating immediate weight-bearing is important. A variety of implants are commonly used to treat geriatric distal femur fractures. Patients with distal femur fracture commonly have weight-bearing restrictions in the immediate postoperative period. A large proportion of orthopaedic trauma surgeons have clinical equipoise for an RCT to investigate the impact of surgical construct and weight-bearing on geriatric distal femur fracture patient recovery.

Education via a mobile application improves health literacy after orthopaedic trauma.

Health literacy is often poor among trauma patients. We introduced an educational mobile application to newly injured patients. We hypothesized that patients who utilized the app would be more informed about their injury and treatment recommendations, and that app users would demonstrate greater adherence to treatment recommendations. Prospective, cohort study. Level 1 trauma centerPatients/participants: Adult patients with acute orthopaedic injury. App with educational information about injuries, treatment, and recovery. bit.ly/traumaapp. Survey regarding knowledge about injury and treatment, and adherence to recommendations. 339 patients were enrolled: 187 received information about the app; 105 of them used the app. Another 234 patients had no prior knowledge about the app. App users were more often female (56.2% vs. 37.6%, p=0.002). App users were more likely to have completed college (34.3% vs. 13.7%, p<0.0001). Better health literacy was noted among app users in all measurements, including knowledge of: fracture location (69% vs. 39%, p<0.0001), treatment (100% vs. 93%, p=0.002), weightbearing status (96% vs. 88%, p=0.001), estimated healing time (63% vs. 26%, p<0.0001), and DVT prophylaxis (93% vs. 81%, p=0.003). Patients who used the app were more likely to have accurate knowledge in all assessed categories, with over 99% reporting adherence to weightbearing recommendations. It is probable that this level of knowledge and engagement will enhance various outcomes after injury. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Validation Testing of a New Crutch Tip Biofeedback Device for Prescribed Lower Extremity Weight-Bearing

Introduction: Modified weight-bearing recommendations are commonly prescribed after surgical intervention for injuries to the lower extremity to reduce the risk of nonunion and delayed healing associated with load bearing through the injured limb and to combat the deleterious effects of immobility. The physical therapist (PT) in the acute care setting is likely to instruct patients after lower extremity injury in weight-bearing-restricted ambulation. A new device is now available for use in the training of weight-bearing status. The study examines whether the ComeBack Mobility crutch tip reporting weight-bearing on the lower extremity is a reliable and valid tool in determining force when compared with the gold standard force plate measurement of lower extremity weight-bearing. Review of Literature: Previous studies have shown that patients are often not able to adequately learn or adhere to restrictive weight-bearing modifications. This may be due to an inability to provide immediate and ongoing feedback on weight-bearing. The new ComeBack Mobility crutch tip system is now available for the acute care PT to use in instruction and for patients to receive real-time feedback throughout their rehabilitation process. Subjects: A sample of convenience of 6 able-bodied PTs was used. Methods: Each subject performed 30 trials of axillary crutch-assisted weight-bearing ambulation using the new device. The weight-bearing reported by the device was compared with the weight-bearing measured through force plates via correlations, t tests, and Bland-Altman plot. Results: The new device demonstrated moderate-good reliability in the measurement of non-weight-bearing and 50% partial weight-bearing in trials completed. Discussion and Conclusion: The ComeBack Mobility crutch tip system could be useful and should be considered for clinical use as a reliable and valid tool in providing auditory feedback for compliance to a prescribed weight-bearing protocol. The system could be useful in the training of patients in the first use of crutches such as prior to discharge from an acute care hospital. Further research is needed with clinical populations as well as with varied weight-bearing protocols.

Postoperative weight-bearing restrictions andrehabilitation protocols after hip arthroscopy forfemoroacetabular impingement: a systematic review.

Despite recent increased interest in hip arthroscopy for the management of femoroacetabular impingement (FAI), there is little evidence to guide weight-bearing recommendations and rehabilitation postoperatively. The primary objective of this study was to determine if sufficient evidence exists to recommend specific weight-bearing restrictions postoperatively. This study was registered with PROSPERO (CRD42021247741). PubMed, MEDLINE and Embase were searched on 3 March 2023 for Level I-IV studies including patients over the age of 18 years, with a minimum 1-year follow-up and reporting of a weight-bearing status, a patient-reported outcome measure (PROM) and a clinical outcome. Meta-analysis was precluded due to heterogeneity in the included studies, and a descriptive analysis was undertaken. Methodological quality and risk of bias were assessed with the methodological index for non-randomized studies (MINORS). Twenty-four studies including 2231 patients who underwent hip arthroscopy for treatment of FAI were included (follow-up interval 33.2 ± 24.7 months). Most articles (62.5%) were case series. There were seven terms describing weight-bearing recommendations, with 83% being some variation of 'partial weight-bearing'. Eight PROMs were reported, with 83% using the modified Harris Hip Score and 87.5% of studies reporting reoperation rates. Only 75% of studies reported rehabilitation protocols. The average MINORS score was 11.07 ± 1.10 out of 16 for non-comparative studies and 18.22 ± 1.48 out of 24 for comparative studies. The reporting of weight-bearing status, clinical outcomes, PROMs and rehabilitation parameters remains poor. At present, sufficient comparative evidence does not exist to make specific weight-bearing recommendation postoperatively.

Simulation-based prediction of bone healing and treatment recommendations for lower leg fractures: Effects of motion, weight-bearing and fibular mechanics.

Despite recent experimental and clinical progress in the treatment of tibial and fibular fractures, in clinical practice rates of delayed bone healing and non-union remain high. The aim of this study was to simulate and compare different mechanical conditions after lower leg fractures to assess the effects of postoperative motion, weight-bearing restrictions and fibular mechanics on the strain distribution and the clinical course. Based on the computed tomography (CT) data set of a real clinical case with a distal diaphyseal tibial fracture, a proximal and a distal fibular fracture, finite element simulations were run. Early postoperative motion data, recorded via an inertial measuring unit system and pressure insoles were recorded and processed to study strain. The simulations were used to compute interfragmentary strain and the von Mises stress distribution of the intramedullary nail for different treatments of the fibula, as well as several walking velocities (1.0km/h; 1.5km/h; 2.0km/h) and levels of weight-bearing restriction. The simulation of the real treatment was compared to the clinical course. The results show that a high postoperative walking speed was associated with higher loads in the fracture zone. In addition, a larger number of areas in the fracture gap with forces that exceeded beneficial mechanical properties longer was observed. Moreover, the simulations showed that surgical treatment of the distal fibular fracture had an impact on the healing course, whereas the proximal fibular fracture barely mattered. Weight-bearing restrictions were beneficial in reducing excessive mechanical conditions, while it is known that it is difficult for patients to adhere to partial weight-bearing recommendations. In conclusion, it is likely that motion, weight bearing and fibular mechanics influence the biomechanical milieu in the fracture gap. Simulations may improve decisions on the choice and location of surgical implants, as well as give recommendations for loading in the postoperative course of the individual patient.

Weight-bearing Restrictions after Distal Femur Fractures - Review of Current Literature.

The incidence of distal femur fractures increases in the geriatric patient. The primary treatment goal in these fractures is early mobilisation to prevent secondary injuries associated with immobility. In light of the increasing spectrum of therapeutic options for postoperative fracture treatment, including double plating, nail-plate combination and distal femur replacement as postoperative treatments, weight-bearing recommendations are becoming increasingly important. The aim of this study was thus to analyse the weight-bearing recommendations and associated therapy results within the literature of the past 9 years and compare the recommendations to our own approach.

Weight-bearing recommendations after operative fracture treatment-fact or fiction? Gait results with and feasibility of a dynamic, continuous pedobarography insole.

Rehabilitation after lower-extremity fractures is based on the physicians' recommendation for non-, partial-, or full weight-bearing. Clinical studies rely on this assumption, but continuous compliance or objective loading rates are unknown. The purpose of this study was to determine the compliance to weight-bearing recommendations by introducing a novel, pedobarography system continuously registering postoperative ground forces into ankle, tibial shaft and proximal femur fracture aftercare and test its feasibility for this purpose. In this prospective, observational study, a continuously measuring pedobarography insole was placed in the patients shoe during the immediate post-operative aftercare after ankle, tibial shaft and intertrochanteric femur fractures. Weight-bearing was ordered as per the institutional standard and controlled by physical therapy. The insole was retrieved after a maximum of sixweeks (28days [range 5-42days]). Non-compliance was defined as a failure to maintain, or reach the ordered weight-bearing within 30%. Overall 30 patients were included in the study. Fourteen (47%) of the patients were compliant to the weight-bearing recommendations. Within twoweeks after surgery patients deviated from the recommendation by over 50%. Sex, age and weight did not influence the performance (p>0.05). Ankle fracture patients (partial weight-bearing) showed a significantly increased deviation from the recommendation (p=0.01). Our study results show that, despite physical therapy training, weight-bearing compliance to recommended limits was low. Adherence to the partial weight-bearing task was further decreased over time. Uncontrolled weight-bearing recommendations should thus be viewed with caution and carefully considered as fiction. The presented insole is feasible to determine weight bearing continuously, could immediately help define real-time patient behaviour and establish realistic, individual weight-bearing recommendations.

Anew continuous gait analysis system for ankle fracture aftercare

Correct aftercare following lower extremity fractures remains acontroversial issue. Reliable, clinically applicable weight-bearing recommendations have not yet been defined. The aim of the current study was to establish anew gait analysis insole during physical therapy aftercare of ankle fractures to test patients' continuous, long-term compliance to partial weight-bearing restrictions and investigate whether patients can estimate their weight-bearing compliance. The postoperative gait of 14patients after operative treatment of WeberB-type ankle fractures was monitored continuously for six weeks (OpenGO, Moticon GmbH, Munich). All patients were instructed and trained by physical therapists on how to maintain partial weight-bearing for this time. Discontinuous (three, six and twelve weeks) clinical (patient questionnaire, visual analogue pain score [VAS]) and radiographic controls were performed. Despite the set weight-bearing limits, individual ranges for overall weight-bearing (range 5-107% of the contralateral side) and patient activity (range 0-366 min/day) could be shown. Agood correlation between weight-bearing and pain was seen (rs= -0.68; p= <0.0001). Patients significantly underestimated their weight-bearing time over the set limit (2.3± 1.4 min/day vs. real: 12.6± 5.9 min/day; p< 0.01). Standardized aftercare protocols and repeated training alone cannot ensure compliance to postoperative partial weight-bearing. Patients unconsciously increased weight-bearing based on their pain level. This study shows that new, individual and possibly technology-assisted weight-bearing regimes are needed. The introduced measuring device is feasible to monitor and steer patient weight-bearing during future studies.

Weight-bearing recommendations after first metatarsophalangeal joint arthrodesis fixation: a biomechanical comparison

BackgroundThis study sought to determine whether several metatarsophalangeal (MTP) fusion techniques require complete immobilization or if some level of weight-bearing could be recommended after surgery. A comparison of synthetic composite to actual bone was included in order to examine the validity of the testing conditions.MethodsFour MTP fusion modalities were tested in synthetic composite bone models: unlocked plating, locked plating, crossed lag screws, and an unlocked plate with a single lag screw. Stiffness was calculated and then used to find the two most rigid constructs; the load to failure was recorded. Stiffness and load to failure testing for the two more rigid constructs in paired cadaveric bones were followed.ResultsThe unlocked plate plus screw and crossed screw constructs were stiffest (p < 0.008). Loads to failure of the unlocked plate plus screw and crossed screws in synthetic bone were 131 and 101 N, respectively and in cadaveric bone were 154 and 94 N, respectively, which are less than the estimated 25% body weight required at the MTP joint. The plate plus screws were statistically more stiff than crossed screws (p = 0.008), but there was no statistical difference between synthetic and cadaveric bone in load to failure (p = 0.296).ConclusionsThe plate plus screw offered the greatest stiffness; the failure test showed that no construct could withstand weight-bearing as tolerated; and, synthetic composite models of the MTP joint did not provide the consistent results in stiffness and failure.

Analysis of 213 currently used rehabilitation protocols in foot and ankle fractures

IntroductionFractures of the ankle, hind- and midfoot are amongst the five most common fractures. Besides initial operative or non-operative treatment, rehabilitation of the patients plays a crucial role for fracture union and long term functional outcome. Limited evidence is available with regard to what a rehabilitation regimen should include and what guidelines should be in place for the initial clinical course of these patients. This study therefore investigated the current rehabilitation concepts after fractures of the ankle, hind- and midfoot. MethodsWritten rehabilitation protocols provided by orthopedic and trauma surgery institutions in terms of recommendations for weight bearing, range of motion (ROM), physiotherapy and choice of orthosis were screened and analysed. All protocols for lateral ankle fractures type AO 44A1, AO 44B1 and AO 44C1, for calcaneal fractures and fractures of the metatarsal as well as other not specific were included. Descriptive analysis was carried out and statistical analysis applied where appropriate. Results209 rehabilitation protocols for ankle fractures type AO 44B1 and AO 44C1, 98 for AO 44A1, 193 for metatarsal fractures, 142 for calcaneal fractures, 107 for 5th metatarsal base fractures and 70 for 5th metatarsal Jones fractures were evaluated. The mean time recommended for orthosis treatment was 6.04 (SD 0.04) weeks. While the majority of protocols showed a trend towards increased weight bearing and increased ROM over time, the best consensus was noted for weight bearing recommendations. ConclusionOur study shows that there exists a huge variability in rehabilitation of fractures of the ankle-, hind- and midfoot. This may be contributed to a lack of consensus (e.g. missing publication of guidelines), individualized patient care (e.g. in fragility fractures) or lack of specialization. This study might serve as basis for prospective randomized controlled trials in order to optimize rehabilitation for these common fractures.