Analysis of partial weight bearing after surgical treatment in patients with injuries of the lower extremity

• Published in: Archives of orthopaedic and trauma surgery Vol. 142; no. 1; pp. 77 - 81
• Main Authors: Eickhoff, Alexander Maximilian, Cintean, Raffael, Fiedler, Carina, Gebhard, Florian, Schütze, Konrad, Richter, Peter H.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-01-2022; Springer Nature B.V
• Subjects: Age; Aged; Body mass index; Fractures; Gait; Humans; Injuries; Lower Extremity - surgery; Medicine; Medicine & Public Health; Orthopaedic Surgery; Orthopedics; Pain; Patient Compliance; Patients; Postoperative Period; Statistical analysis; Surgery; Trauma; Weight-Bearing; Partial weight bearing; Loading; Electronic shoe soles
• ISSN: 0936-8051; 1434-3916
• DOI: 10.1007/s00402-020-03588-z

Introduction
After surgical treatment of injuries of the lower extremity, partial weight bearing is often suggested until soft tissue consolidation. It is doubtful, if this recommendation can be implemented, even in the case that a patient is performing partial weight bearing with a physical therapist. Consequently the question remains, if patients are able to implement partial weight bearing after surgery and which factors favor incompliance.
Materials and methods
49 patients, who underwent surgical treatment after injuries of the lower extremity, were equipped with electronic shoe insoles on both sides. Different weight bearing instructions were given depending on the type of injury and surgery (full weight bearing vs. 20 kg weight bearing vs. non-weight bearing). Besides loading, other factors like age, gender, weight and physical activity were evaluated. Statistical analysis was performed using Chi-square and Fisher’s exact test with significance set at a
p
value < 0.05.
Results
25 of the 40 patients, who had to perform non- or partial weight bearing, were not able to follow postoperative instructions (compliance rate 37.5%). The average loading of the whole collective was 32.6 kg (4.8–109.2 kg). The specification of loading had no statistically significant influence on real loading (
p
-value 0.39). Elderly patients were less able to follow instructions than younger patients (36 vs 30.2 kg). Physically active compared to non-active patients overloaded their injured extremity (37.8 vs 28.7 kg). Patients with a high body mass index (BMI) encountered more difficulties to perform partial weight bearing than lightweight patients (36.9 vs 25.1 kg).
Conclusions
Most patients were not able to follow loading limitation, even a few days after surgery and even if the patients were trained by a physiotherapist. Excessive weight bearing-related complications should be evaluated.