DOS BULLETIN - Dansk Ortopædisk Selskab
DOS BULLETIN - Dansk Ortopædisk Selskab DOS BULLETIN - Dansk Ortopædisk Selskab
2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 92 Can immediate weight bearing be allowed following locking plate osteosynthesis of proximal tibial fractures? Tobias Haak, Henrik Palm, Kim Holck, Michael Krasheninnikoff, Peter Gebuhr, Anders Troelsen Hvidovre University Hospital Background: Traditionally, immediate weight bearing following osteosynthesis of proximal tibial fractures is not allowed due to fear of intraarticular fracture collapse. Locking plates could however improve stability of osteosynthesis and optimize support of the articular surfaces. Thus, allowing greater loading forces. Purpose: To investigate if immediate weight bearing can be allowed following locking plate osteosynthesis of proximal tibial fractures. Methods: We retrospectively assessed all locking plate osteosynthesis of proximal tibial fractures operated from Nov. 2007 to Sep. 2009. Patient demographics, complications, reoperations and radiographic outcome at 6-8 week follow-up were assessed. The study group consisted of 42 patients (23 females/19 men) with a mean age of 50 yrs (range: 21-88 yrs). The median ASA score was 1 (range: 1-3) and cognitive impairment was found in 2 patients. The fracture distribution was: Partial intraarticular AO type 41B (n=36); Complete intraarticular AO type 41C3 (n=4); Extraarticular AO type 41A (n=2). Two groups were compared: 26 patients were not allowed to bear weight within the first 6-8 weeks, and 16 were allowed to bear weight immediately postoperative. Findings: Groups were comparable with respect to demographic parameters and distribution of fracture types (p=0.14- 0.95). The use of bone allograft, the number of screws inserted, and the application of postoperative Don-Joy bandage were comparable between groups (p= 0.17, 0.73 and 0.55). Overall, persisting depressions of the articular surface ranged from 0-5 mm postoperatively with no difference between groups (p=0.26). At follow-up 6-8 weeks postoperative no patients were reoperated, and no changes in radiographic configuration of the fracture site were observed in either group. Conclusion: Given the retrospective design it seems that immediate weightbearing following locking plate osteosynthesis of proximal tibial AO type 41B fractures can be allowed. Future prospective studies are needed. 92
2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 93 Preoperative factors predicting in-hospital outcome in patients with hip fracture following multimodal fast-track rehabilitation concept Morten Tange Kristensen, Henrik Kehlet Department of Physiotherapy and Orthopaedic Surgery & Section of Surgical Pathophysiology, Copenhagen University Hospital at Rigshospitalet Background: The concept of multimodal rehabilitation of patients with hip fracture has proven effective. Still, some patients do not regain their previous basic mobility independency in the acute orthopaedic setting. Thus, clinicians need to know the potential of each patient. Purpose: Previous models established a low prefracture New Mobility Score (NMS), in addition to older age and having an intertrochanteric fracture as independent predictors of outcome. Still, such models need to be confirmed. The aim was to examine the validity of previously established models of in- hospital outcome after hip fracture surgery. Methods: A total of 213 consecutive patients (157 women and 56 men) with a median age of 82 (IQR, 75-88) years, admitted from their own home to a special hip fracture unit, and following a multimodal optimised rehabilitation concept. Outcome variables were the regain of independency in basic mobility during admittance and discharge destination. The Cumulated Ambulation Score was used to evaluate basic mobility defined as; independency in getting in and out of bed, sitting down and standing up from a chair, and walking. Discharge destination was classified as own home or further inpatient rehabilitation facilities in the community. Findings: Multiple logistic regression analysis, revealed the prefracture NMS functional level, age and fracture types as the only independent predictors, when adjusted for gender, mental and health status. Thus, a patient with a low prefracture NMS and/or an intertrochanteric fracture was respectively, 6 and 4 times more likely not to regain independency in basic mobility during admittance, and 4 and 3 times more likely not being discharged to own home, compared to a patient with a high prefracture NMS level and a cervical fracture, respectively. Correspondingly, multiple linear regression analyses showed that patients with a low prefracture NMS level and/or an intertrochanteric fracture, who actually did regain independent mobility, required on average 2.3 and 2.6 days more to achieve this functional level. Further, odds of not being discharged directly to own home increased with 9% per each additional year a patient got older. Conclusion: The prefracture NMS, age and fracture type were confirmed as independent predictors of in-hospital outcome in patients with hip fracture who followed a multimodal rehabilitation concept. Thus, clinicians, using these three easily available variables, have the possibility to spot patients who may benefit from special attention and more intensive training. 93
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2010-378_<strong>DOS</strong> nr. 3 2010 29/09/10 10:08 Side 93<br />
Preoperative factors predicting in-hospital outcome<br />
in patients with hip fracture following multimodal<br />
fast-track rehabilitation concept<br />
Morten Tange Kristensen, Henrik Kehlet<br />
Department of Physiotherapy and Orthopaedic Surgery & Section of<br />
Surgical Pathophysiology,<br />
Copenhagen University Hospital at Rigshospitalet<br />
Background: The concept of multimodal rehabilitation of patients with hip<br />
fracture has proven effective. Still, some patients do not regain their previous<br />
basic mobility independency in the acute orthopaedic setting. Thus, clinicians<br />
need to know the potential of each patient.<br />
Purpose: Previous models established a low prefracture New Mobility Score<br />
(NMS), in addition to older age and having an intertrochanteric fracture as independent<br />
predictors of outcome. Still, such models need to be confirmed. The<br />
aim was to examine the validity of previously established models of in- hospital<br />
outcome after hip fracture surgery.<br />
Methods: A total of 213 consecutive patients (157 women and 56 men) with a<br />
median age of 82 (IQR, 75-88) years, admitted from their own home to a special<br />
hip fracture unit, and following a multimodal optimised rehabilitation concept.<br />
Outcome variables were the regain of independency in basic mobility during<br />
admittance and discharge destination. The Cumulated Ambulation Score<br />
was used to evaluate basic mobility defined as; independency in getting in and<br />
out of bed, sitting down and standing up from a chair, and walking. Discharge<br />
destination was classified as own home or further inpatient rehabilitation facilities<br />
in the community.<br />
Findings: Multiple logistic regression analysis, revealed the prefracture NMS<br />
functional level, age and fracture types as the only independent predictors, when<br />
adjusted for gender, mental and health status. Thus, a patient with a low prefracture<br />
NMS and/or an intertrochanteric fracture was respectively, 6 and 4<br />
times more likely not to regain independency in basic mobility during admittance,<br />
and 4 and 3 times more likely not being discharged to own home, compared<br />
to a patient with a high prefracture NMS level and a cervical fracture,<br />
respectively. Correspondingly, multiple linear regression analyses showed that<br />
patients with a low prefracture NMS level and/or an intertrochanteric fracture,<br />
who actually did regain independent mobility, required on average 2.3 and 2.6<br />
days more to achieve this functional level. Further, odds of not being discharged<br />
directly to own home increased with 9% per each additional year a patient got<br />
older.<br />
Conclusion: The prefracture NMS, age and fracture type were confirmed as<br />
independent predictors of in-hospital outcome in patients with hip fracture who<br />
followed a multimodal rehabilitation concept. Thus, clinicians, using these three<br />
easily available variables, have the possibility to spot patients who may benefit<br />
from special attention and more intensive training.<br />
93