International Orthopaedics

| 2017

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

Purpose

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.

Methods

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 six weeks (28 days [range 5–42 days]). Non-compliance was defined as a failure to maintain, or reach the ordered weight-bearing within 30%.

Results

Overall 30 patients were included in the study. Fourteen (47%) of the patients were compliant to the weight-bearing recommendations. Within two weeks 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).

Conclusions

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.

Keywords

Weight-bearing, Compliance, Pedobarography, Gait analysis

Author/s

Benedikt J. Braun, Steven C. Herath, Nils T. Veith, Mika Rollmann, Jörg H. Holstein, Marcel Orth, Tim Pohlemann

Institution / Department

Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital

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