scholarly journals How do orthopaedic surgeons and rehabilitation professionals interpret and assess ‘toe touch’ weight bearing and ‘partial’ weight bearing status in the rehabilitation setting?

2018 ◽  
Vol 4 (1) ◽  
pp. e000326 ◽  
Author(s):  
Stephen G Thompson ◽  
Rhodri D Phillip ◽  
Andrew Roberts
Keyword(s):  
Weight Bearing ◽  
Total Body Weight ◽  
Medical Rehabilitation ◽  
Partial Weight Bearing ◽  
Rehabilitation Centre ◽  
Orthopaedic Surgeons ◽  
Rehabilitation Professionals ◽  
Wide Range ◽  
Significant Difference ◽  
Partial Weight

AimTo compare the interpretation of toe touch weight bearing (TTWB) and partial weight bearing (PWB) among orthopaedic surgeons, rehabilitation professionals and patients.Methodology78 consultant and middle-grade orthopaedic surgeons in the UK completed a questionnaire. 64 rehabilitation professionals (including physiotherapists) at Defence Medical Rehabilitation Centre Headley Court were also recruited. Both groups provided their interpretation of TTWB and PWB as a percentage of total body weight (%TBW). Each rehabilitation professional, then applied what they interpreted to be TTWB and PWB using a Lasar Posture weighing device. The predicted values were compared with the actual values demonstrated.ResultsThere was no significant difference between orthopaedic surgeons and rehabilitation professionals in their interpretation of TTWB and PWB, however there was a wide range of responses. There was a significant difference between the predicted %TBW and the actual values demonstrated by the ‘educated patient’ (mean difference 4.8 (TTWB) and 22.9 (PWB)).ConclusionHealthcare professionals vary greatly in their interpretation of the terms TTWB and PWB. Therefore, for a consistency in rehabilitation delivery the terms should not be used in isolation without a further descriptor. Static measures of weight application are lower than people think they are applying. We encourage the use of loading practice with a scale to reassure and educate patients.

scholarly journals Titanium Acetabular Component Deformation under Cyclic Loading

Materials ◽  
2019 ◽  
Vol 13 (1) ◽  
pp. 52
Author(s):  
Nicholas A. Beckmann ◽  
Rudi G. Bitsch ◽  
Theresa Bormann ◽  
Steffen Braun ◽  
Sebastian Jaeger
Keyword(s):  
Repeated Measures ◽  
Weight Bearing ◽  
Acetabular Defect ◽  
Acetabular Cup ◽  
Partial Weight Bearing ◽  
Significant Difference ◽  
The Mean ◽  
Partial Weight ◽  
Acetabular Components ◽  
Best Fit

Acetabular cup deformation may affect liner/cup congruency, clearance and/or osseointegration. It is unclear, whether deformation of the acetabular components occurs during load and to what extent. To evaluate this, revision multi-hole cups were implanted into six cadaver hemipelvises in two scenarios: without acetabular defect (ND); with a large acetabular defect (LD) that was treated with an augment. In the LD scenario, the cup and augment were attached to the bone and each other with screws. Subsequently, the implanted hemipelvises were loaded under a physiologic partial-weight-bearing modality. The deformation of the acetabular components was determined using a best-fit algorithm. The statistical evaluation involved repeated-measures ANOVA. The mean elastic distension of the ND cup was 292.9 µm (SD 12.2 µm); in the LD scenario, 43.7 µm (SD 11.2 µm); the mean maximal augment distension was 79.6 µm (SD 21.6 µm). A significant difference between the maximal distension of the cups in both scenarios was noted (F(1, 10) = 11.404; p = 0.007). No significant difference was noted between the compression of the ND and LD cups, nor between LD cups and LD augments. The LD cup displayed significantly lower elastic distension than the ND cup, most likely due to increased stiffness from the affixed augment and screw fixation.

scholarly journals Three different interlocking intramedullary nails for unstable reverse oblique inter-trochanteric fractures: a bio-mechanical comparative study

2016 ◽  
Vol 2 (4) ◽  
pp. 280
Author(s):  
Ujjwal K. Debnath ◽  
S. Naidu Maripuri ◽  
K. N. Subramanian ◽  
K. Mohanty
Keyword(s):  
Intertrochanteric Fracture ◽  
Weight Bearing ◽  
Biomechanical Analysis ◽  
Full Weight Bearing ◽  
Peak Strain ◽  
Intertrochanteric Fractures ◽  
Partial Weight Bearing ◽  
Intramedullary Nails ◽  
Significant Difference ◽  
Partial Weight

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Biomechanical testing, intramedullary devices have proven advantageous over the extramedullary devices in the management of unstable intertrochanteric fractures. Reverse oblique type of intertrochanteric fractures are highly unstable and intramedullary nails are currently the method of internal fixation. The currently available nails seems to provide rotational, axial and angular stability, but biomechanical analysis of the strain pattern in the bone and implant in this fractures are lacking. The aim of this experimental study was to analyse the strain in three different long femoral nail-bone units under physiological loading when implanted in Saw bone model after creating a reverse oblique intertrochanteric fracture.</span></p><p class="abstract"><strong>Methods:</strong> A total of 12 sawbones were divided in to 4 equal groups. Group 1 was intact saw bones and were used as controls. Group 2, Group 3 and Group 4 were implanted with Depuy, Stryker and Synthes nails respectively after creating a reverse oblique intertrochanteric fracture. All the four groups were axially loaded with 100 N increments until physiological loads. The strain patterns were measured at the posteromedial cortex and the peak strains were extracted at partial weight bearing i.e. 500 N and full weight bearing physiological loads i.e. 1000 N.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">There was no significant difference in peak strains among the groups at partial loads. However at 1000 N loads the peak strain in the DePuy nail-bone unit was significantly high compared to the other two nail-bone units and the controls. </span></p><p class="abstract"><strong>Conclusions:</strong> These results question the safety of immediate full weight bearing following surgery when treating the reverse oblique unstable fractures with DePuy intramedullary nails. A period of partial weight bearing following fixation of reverse oblique fractures would be wise when using DePuy nails<span lang="EN-IN">.</span></p>

scholarly journals Differences in femoral component subsidence rate after THA using an uncemented collarless femoral stem: full weight-bearing with an enhanced recovery rehabilitation versus partial weight-bearing

2021 ◽  
Author(s):  
Franziska Leiss ◽  
Julia Sabrina Götz ◽  
Matthias Meyer ◽  
Günther Maderbacher ◽  
Jan Reinhard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Enhanced Recovery ◽  
Weight Bearing ◽  
Femoral Stem ◽  
Full Weight Bearing ◽  
Partial Weight Bearing ◽  
Fill Ratio ◽  
Stem Subsidence ◽  
Partial Weight

Abstract Background Femoral component subsidence is a known risk factor for early failure of total hip arthroplasty (THA) using cementless stems. The aim of the study was to compare an enhanced recovery concept with early full weight-bearing rehabilitation and partial weight-bearing on stem subsidence. In addition, the influence of patient-related and anatomical risk factors on subsidence shall be assessed. Methods One hundred and fourteen patients underwent primary cementless THA and were retrospectively analyzed. Sixty-three patients had an enhanced recovery rehabilitation with early full weight-bearing and 51 patients had rehabilitation with partial weight-bearing (20 kg) for 6 weeks. Postoperative subsidence was analyzed on standing pelvic anterior–posterior radiographs after 4 weeks and 1 year. Subsidence was measured in mm. Anatomical and prosthetic risk factors (stem size, canal flare index, canal fill ratio as well as BMI and demographic data) were correlated. Results Femoral stem subsidence rate was significantly higher for the group with an enhanced recovery concept compared to the group with partial weight-bearing at the first radiological follow up after 4 weeks [2.54 mm (SD ± 1.86) vs. 1.55 mm (SD ± 1.80)] and the second radiological follow up after 1 year [3.43 mm (SD ± 2.24) vs. 1.94 (SD ± 2.16)] (p < 0.001, respectively). Stem angulation > 3° had a significant influence on subsidence. Canal flare index and canal fill ratio showed no significant correlation with subsidence as well as BMI and age. Conclusion In the present study, cementless stem subsidence was significantly higher in the group with enhanced recovery rehabilitation compared to partial weight-bearing. Small absolute values and differences were demonstrated and therefore possibly below clinical relevance. Anatomical radiological parameters and anthropometric data did not appear to be risk factors for stem subsidence.

scholarly journals Femoral neck stress fracture in a young female recruit: case report

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 16 ◽  
Author(s):  
Hélder Fonte ◽  
Ricardo Rodrigues-Pinto
Keyword(s):  
Femoral Neck ◽  
Stress Fracture ◽  
Early Recognition ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Imaging Studies ◽  
Partial Weight Bearing ◽  
Military Recruit ◽  
Femoral Neck Stress Fracture ◽  
Partial Weight

Introduction: Femoral neck stress fractures are uncommon and depending on their location, can be at high risk for non-union and significant morbidity.  Their prevalence is higher among runners and military recruits, and women seem to be at higher risk. Methods: A 27-year-old female, who was enrolled in military recruit, reported left side groin pain after a strenuous running exercise. Due to persistent pain an X-Ray was ordered, which revealed no signs of acute lesions. Further imaging studies with CT scan and MRI identified a compression-type femoral neck stress fracture. Results: The patient was submitted to conservative treatment consisting of restricting from full weight-bearing. Six weeks after she initiated partial weight-bearing, becoming asymptomatic at seven months. Follow-up imaging studies revealed union of the fracture. Discussion: This diagnosis should be considered when evaluating military and athlete populations. Early recognition of these injuries is crucial because complication and morbidity rates are high.

scholarly journals Surgical Repair of Open Achilles Tendon Injuries Using No.1 Prolene to Pull Down the Proximal Tendon: A Safe Technique

1970 ◽  
Vol 21 (2) ◽  
pp. 132-134
Author(s):  
Sayed Ahmed ◽  
Debashis Roy ◽  
S Uddin Ahmed ◽  
M Enamul Haque ◽  
Moshidur Rahman
Keyword(s):  
Suture Material ◽  
Weight Bearing ◽  
Full Range ◽  
Neutral Position ◽  
Partial Weight Bearing ◽  
Active Flexion ◽  
Safe Technique ◽  
Partial Weight ◽  
Distal Tendon

From July 1998 to October 2004 forty-seven patients with open tendo-Achilles injuries were treated pull down the proximal tendon with no.1 prolene. In this surgical method no.1 prolene was threaded through the proximal tendon and the same suture material passed through the distal tendon and its bilateral ends were tightened over the rubber button either under the heel or by the sides of the heel. Box sutures apposed cut ends of the tendon. The ankle was placed in the cast in near neutral position. At six weeks the cast was removed and active flexion program was started. Partial weight bearing was allowed at seven weeks and full bearing was allowed at ten weeks after surgery. The average follow up period is 1.8 years. All the patients exhibited full range of motion at the final follow-up. doi: 10.3329/taj.v21i2.3792 TAJ 2008; 21(2): 132-134

scholarly journals Comparison of 8-year knee osteoarthritis progression in 2 siblings: a case-based review

2020 ◽  
Author(s):  
Margaret L. Gourlay ◽  
Linda L. Gourlay
Keyword(s):  
Knee Osteoarthritis ◽  
Fluid Model ◽  
Weight Bearing ◽  
Knee Injuries ◽  
Original Research ◽  
Partial Weight Bearing ◽  
Clinical Model ◽  
Pubmed Database ◽  
The Right ◽  
Partial Weight

Abstract Because the pathophysiology of knee osteoarthritis is poorly understood, optimal evidence-based clinical management is uncertain. Sibling comparison studies can help inform a clinical model to guide preventive care. We compared the 8-year clinical outcomes in 2 sisters with a family history of osteoarthritis, normal BMI, and absence of knee pain at baseline. Both patients had Kellgren–Lawrence grade 1 in the affected knee at the time of twisting knee injuries leading to osteoarthritis diagnoses at age 50 (patient 1) and 51 (patient 2). Patient 1 developed a chronic right knee effusion, and progressed to Kellgren–Lawrence grade 3 bilaterally by the time she had a right total knee replacement at age 58. Patient 2 had subchondral fractures of the right knee with transient effusion, which healed after 1 year of partial weight-bearing with crutches and subsequent daily use of knee sleeves. Patient 2 had Kellgren–Lawrence grade 0 bilaterally upon surveillance imaging at age 58. The terms “osteoarthritis and knee and diagnostic imaging and subchondral bone and pathophysiology” were searched in the PubMed database to identify original research articles to inform a clinical model consistent with the patients’ outcomes. A fluid model of osteoarthritis was the best explanatory model for the discordant clinical trajectories of the age-matched siblings. Patient recommendations are presented based on these findings.

scholarly journals Comparison of two reinforcement rings for primary total hip arthroplasty addressing displaced acetabular fractures: a biomechanical analysis

2020 ◽  
Vol 140 (12) ◽  
pp. 1947-1954
Author(s):  
Johannes Becker ◽  
M. Winkler ◽  
C. von Rüden ◽  
E. Bliven ◽  
P. Augat ◽  
...  
Keyword(s):  
Acetabular Fracture ◽  
Weight Bearing ◽  
Biomechanical Analysis ◽  
Acetabular Fractures ◽  
Full Weight Bearing ◽  
Acetabular Cup ◽  
Partial Weight Bearing ◽  
Quadrilateral Plate ◽  
Stable Conditions ◽  
Partial Weight

Abstract Introduction Aim of this study was to biomechanically compare two different acetabular cup fixation constructs in terms of fracture fixation for displaced acetabular fractures involving the anterior column with hemitransverse fracture under partial and full weight-bearing conditions. Methods Two different reinforcement rings designed as cages for primary THA were biomechanically tested in terms of managing a complex acetabular fracture. Single-leg stance cyclic loading was performed to assess fracture gap movement and fragment rotation. Twelve hemi pelvis Sawbones were divided into two groups: primary THA with acetabulum roof reinforcement plate (ARRP) (n = 6) and primary THA with Burch–Schneider reinforcement cage (BSRC) (n = 6). Results During loading under partial weight-bearing (250 N) fracture gap movement tended to be larger in the BSRC group as compared to the ARRP group. Under full weight-bearing conditions, the ARRP showed 60% significantly less motion (p = 0.035) of the os ilium to os ischii gap compared to BSRC. Fracture gap movements between the os ilium and spina iliaca fragments were significantly reduced by 76% (p = 0.048) for ARRP in contrast to BSRC. The ARRP group also demonstrated significantly less movement in the fracture gaps os ischii to quadrilateral plate (62% reduction, p = 0.009) and quadrilateral plate to spina iliaca (87% reduction, p < 0.001). Significantly less rotational movement of the quadrilateral plate to the os ilium was exhibited by the ARRP group (p = 0.015). Conclusions The presented acetabulum roof-reinforcement plate (ARRP) provides stable conditions at the acetabular component with adequate stabilization of a displaced acetabular fracture.

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