Weight-Bearing Monitoring Devices in Lower Extremity Fractures: A Scoping Review

Abstract

Background: Orthopaedic surgeons commonly prescribe weight-bearing parameters for their patients for a variety of reasons. Weight-bearing may be limited in order to control the healing environment, but advancing a patient's weight-bearing status is preferably done as quickly as possible to maximize functional recovery. However, it is entirely unclear to what extent these prescriptions are followed in practice. The purpose of this scoping review is to identify and compare non-invasive devices used for the measurement of weight-bearing following lower extremity fractures.

Methods: Database searches of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were completed to identify relevant studies. Titles were screened for relevance, and abstracts were screened against the eligibility criteria. We identified studies that investigated the use of external force, pedal pressure, or activity monitoring devices used in adults after lower extremity fractures and excluded studies involving compartment pressure measurement.

Findings: Sixty-two studies met the inclusion criteria. About 39% of studies used an insole-type device, which could be worn in a shoe or integrated into a removable boot. Other device types included step count or activity monitors (52%), force plates (18%), pressure film (2%) and external pedobarography systems (27%).

Interpretation: We found that different monitors offered varying types of measurements and are suitable for a variety of applications. Therefore, selecting the ideal device depends on the metric of interest. Further high-quality prospective studies utilizing device monitoring are needed to validate the theory that early weight-bearing is beneficial and safe for patients with lower extremity fractures.

Keywords: fracture; lower extremity; monitoring; trauma; weight-bearing.

Figure 1

PRISMA diagram. Adapted from Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. under the CC BY 4.0 license.

Figure 2

Moticon OpenGo Insole (Color). Used with permission from moticon.com.