Lower Extremity Periarticular Fractures Clinical Trial
Official title:
Early Standardized Weight Bearing Utilizing Immersion Therapy Following Periarticular Lower Extremity Fractures: Clinical and Radiographic Outcomes
The purpose of this prospective study is evaluate the effect of a standardized early weight bearing physical therapy protocol that utilizes immersion therapy on the clinical outcomes of lower extremity periarticular fractures. The investigators null hypothesis is that the early weight bearing protocol will have the same effect as a traditional 10-week non-weight bearing protocol on clinical outcomes.
Fractures of the lower extremity are common injuries that can lead to temporary or permanent
disability.13 Fracture healing, regardless of treatment, is a multifactorial process that is
influenced by time, biomechanics, and host biology (among other variables). The degree,
timing, progression, and type of weight bearing after fractures involving the pelvis and
lower extremities is an area of debate in the clinical management of a broad spectrum of
orthopedic injuries.1,2,4-9,11,15 Periarticular fractures of weight bearing joints are an
area of particular interest with regard to post-operative weight bearing due to the
prolonged periods that patients must be non-weight bearing after surgery.
Some degree of impairment is inevitable with any traumatic injury. The majority of authors
writing about post-fracture weight bearing have determined that timing and extent of weight
bearing has an effect on fracture healing, while a small number of authors have published
results demonstrating the opposite.14,16,19,21 In addition to potential impacts on healing
rates, limited or non-weight bearing carries the added insult of loss of bone density and
muscle mass.3,10,12,17,20,22
Traditionally, patients with periarticular fractures have been required to be non-weight
bearing on their effected extremity for up to 12 weeks. At this institution, most patients
have been required to remain non-weight bearing for 10 weeks, followed by progressively
increased levels of weight bearing according to patient tolerance. One of the orthopaedic
traumatologists at this institution uses immersion therapy to allow patients with
periarticular fractures to begin weight bearing prior to the ten-week mark.
Immersion therapy requires that patients perform their physical therapy, with a trained
therapist, in a swimming pool. The use of the pool in post-fracture care may be able to
provide a structured and standardized partial weight-bearing environment that could allow
for early mobilization. It also has the potential to improve clinical outcomes by mitigating
at least some of the loss in bone and muscle mass during the post-operative period; thereby,
potentially speeding functional recovery. Immersion therapy is currently utilized on-site at
the University of Utah Orthopedic Center for a variety of diagnoses, including in
post-fracture care.
There is essentially no orthopedic literature regarding immersion therapy in the management
of post-fracture rehabilitation with regard to early weight bearing. Specifically, the
investigators are aware of no clinical outcome studies that investigate standardized early
weight bearing protocols following periarticular fractures of the lower extremity.
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Observational Model: Case Control, Time Perspective: Prospective