International Orthopaedics

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

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

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


Weight-bearing, Compliance, Pedobarography, Gait analysis


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.

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