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. 2018 Jun 6;100(11):936-941.
doi: 10.2106/JBJS.17.01222.

Inability of Older Adult Patients with Hip Fracture to Maintain Postoperative Weight-Bearing Restrictions

Christian Kammerlander  1   2 , Daniel Pfeufer  1 , Leonard Adolf Lisitano  1 , Stefan Mehaffey  1 , Wolfgang Böcker  1 , Carl Neuerburg  1
Affiliations

Inability of Older Adult Patients with Hip Fracture to Maintain Postoperative Weight-Bearing Restrictions

Christian Kammerlander et al. J Bone Joint Surg Am. .

Abstract

Background: For elderly trauma patients, a basic goal is early mobilization, as immobilization can trigger various complications, such as venous thromboembolism, pneumonia, urinary tract infections, and pressure ulcers. Although partial weight-bearing has been shown to significantly increase mortality compared with unrestricted weight-bearing, it remains a frequent recommendation of aftercare following lower-extremity fracture fixation.

Methods: An insole force sensor was used to measure true postoperative weight-bearing by patients ≥75 years of age treated for hip fracture compared with patients 18 to 40 years of age treated for ankle fracture. Both groups were instructed to maintain partial weight-bearing on the affected limb (≤20 kg) postoperatively. Following standardized physiotherapy training, gait analysis was performed.

Results: None of the patients in the elderly test group were able to comply with the weight-bearing restriction as recommended. We found that 69% (11 of 16) of the patients exceeded the specified load by more than twofold, whereas significantly more patients in the younger control group (>75% [14 of 18]) achieved almost the entire weight-bearing restriction (p < 0.001). Only 1 of the elderly patients was able to comply with the predetermined weight-bearing restriction, and only for a short period of time. In comparison, significantly more patients in the control group (89% [16 of 18]; p < 0.001) maintained the partial load for nearly the entire time during gait analysis.

Conclusions: Elderly patients seem to be unable to maintain weight-bearing restrictions. As early mobilization of geriatric trauma patients is an important element for a successful rehabilitation, the directive of postoperative partial weight-bearing for these patients should be abandoned.

Level of evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

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