Postoperative weight bearing and patient reported outcomes at one year following tibial plateau fractures

Autor: Claire F. Jones, Stuart A. Callary, Dominic Thewlis, Mark Rickman, David M. Findlay, Gerald J. Atkins, Viju Daniel Verghese, Lucian B. Solomon, François Fraysse
Přispěvatelé: Thewlis, Dominic, Fraysse, Francois, Callary, Stuart A, Verghese, Viju Daniel, Jones, Claire F, Findlay, David M, Atkins, Gerald J, Rickman, Mark, Solomon, Lucian B
Rok vydání: 2017
Předmět:
Adult
Male
medicine.medical_specialty
Time Factors
Adolescent
Knee Joint
medicine.medical_treatment
Context (language use)
Osteoarthritis
Walking
medicine.disease_cause
weight bearing
Weight-bearing
open reduction and internal fixation
rehabilitation
Weight-Bearing
03 medical and health sciences
Fracture Fixation
Internal
Young Adult
0302 clinical medicine
Quality of life
medicine
Tibial plateau fracture
Internal fixation
Humans
proximal tibia
Patient Reported Outcome Measures
Postoperative Period
General Environmental Science
Aged
Retrospective Studies
Fracture Healing
030222 orthopedics
Impaction
business.industry
030208 emergency & critical care medicine
Middle Aged
medicine.disease
fracture healing
Surgery
Biomechanical Phenomena
Radiography
Tibial Fractures
General Earth and Planetary Sciences
Patient-reported outcome
Female
tibial plateau fracture
business
Zdroj: Injury. 48(7)
ISSN: 1879-0267
Popis: Tibial plateau fractures are complex and the current evidence for postoperative rehabilitation is weak, especially related to the recommended postoperative weight bearing. The primary aim of this study was to investigate if loading in the first 12 weeks of recovery is associated with patient reported outcome measures at 26 and 52 weeks postoperative. We hypothesized that there would be no association between loading and patient reported outcome measures. Seventeen patients, with a minimum of 52-week follow-up following fragment-specific open reduction and internal fixation for tibial plateau fracture, were selected for this retrospective analysis. Postoperatively, patients were advised to load their limb to a maximum of 20 kg during the first 6 weeks. Loading data were collected during walking using force platforms. A ratio of limb loading (affected to unaffected) was calculated at 2, 6 and 12 weeks postoperative. Knee Injury and Osteoarthritis Scores were collected at 6, 12, 26 and 52 weeks postoperative. The association between loading ratios and patient reported outcomes were investigated. Compliance with weight bearing recommendations and changes in the patient reported outcome measures are described. Fracture reduction and migration were assessed on plain radiographs. No fractures demonstrated any measurable postoperative migration at 52 weeks. Significant improvements were seen in all patient reported outcome measures over the first 52 weeks, despite poor adherence to postoperative weight bearing restrictions. There were no associations between weight bearing ratio and patient reported outcomes at 52 weeks postoperative. Significant associations were identified between the loading ratio at 2 weeks and knee-related quality of life at six months (R2 = 0.392), and between the loading ratio at 6 weeks combined with injury severity and knee-related quality of life at 26 weeks (R2 = 0.441). In summary, weight bearing as tolerated does not negatively affect the results of tibial plateau fracture and may therefore be safe for postoperative management. These findings should be taken in context of the sample size, which was not sufficient for sub-group analysis to investigate the role of impaction grafting. Refereed/Peer-reviewed
Databáze: OpenAIRE
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