ArticlePDF Available

Weight Bearing Compliance after Foot and Ankle Surgery

Authors:

Abstract

Category Other Introduction/Purpose Patients are frequently required to maintain a non-weight bearing (NWB) status after foot and ankle surgery in order to prevent post op complications. Adherence to these instructions is of paramount importance and lack of compliance may lead to wound breakdown, loss of fracture fixation, or hardware failure. Unfortunately due to a number of factors, patients are frequently unable to comply with their weight bearing (WB) requirements. Lack of compliance has recently been demonstrated in studies as it relates to either partial or NWB instructions. This study examined rates of non-compliance in a socioeconomically disadvantaged population with results showing an 88% non-compliance rate. We present preliminary data on WB compliance and further seek to identify demographic data and risk factors possibly contributing to this epidemic. Methods Pressure sensing films (70-350 PSI) were used for this study. When pressure is applied, the film turns an intense pink color. After lower extremity surgery is performed patients are placed in a short leg plaster splint. The sensor is placed superficial to the plaster/webril. One sensor is placed beneath both the forefoot and one beneath the hind foot and the splint is then marked with an “S” to indicate study participation. Once the patient follows up, either the attending physician or a certified cast technician will retrieve the sensors for documentation. An additional sensor is placed on a non-weight bearing portion of the anterior tibia to serve as a control. After retrieval of sensors, results are analyzed by at least 4 team members to decide on WB compliance. Pink coloration of 30% or more is considered positive in our study. Results At the time of this abstract, 25 patients had returned for follow up. 22/25 (88%) patients were found to have at least 1 out of 2 sensors positive. 13/25 (52%) had both forefoot and hind foot sensors positive. 3 patients had both sensors without any pressure changes. 5 patients had lost at least 1 sensor. Conclusion To date, 88% of our patients have been found to be non-compliant with their weight bearing status instructions. The results of this study agree with previous studies demonstrating a high rate of non-compliance even after education and instruction. Our study exhibited a higher rate of non-compliance when compared to other studies, possibly due to patient demographics. More data is needed to ascertain the effect of certain risk factors in order to identify the proper method of patient education/instruction and to possibly create a standardized weight bearing compliance educational program.
A
OFAS
A
nnua
l
M
eeting 2016 1
W
eight Bearing Compliance afte
r
Foot and Ankle Surgery
Grigory Gershkovich, MD, Dillon Arango, MD, Gene W. Shaffer, MD, Anthony Ndu, MD, MBA
Category:
Othe
Keywords:
Patient Compliance
Weightbearing
Non-weightbearing
Surgery
Introduction/Purpose: Patients are frequently required
t
o
maintain
a
non-
w
eight
bearing
(NWB) status afte
r
foot
and
ankle
surgery in order to prevent post op complications. Adherence to these instructions is of paramount importance and lack of
compliance may lead to wound breakdown, loss of fracture fixation, or hardware failure. Unfortunately due to a number of factors,
patients are frequently unable to comply with their weight bearing (WB) requirements. Lack of compliance has recently
been demonstrated in studies as it relates to either partial or NWB instructions. This study examined rates of non-compliance in a
socioeconomically disadvantaged population with results showing an 88% non-compliance rate. We present preliminary data on
WB compliance and further seek to identify demographic data and risk factors possibly contributing to this epidemic.
Methods: Pressure sensing films (70-350 PSI) were used
fo
r
t
his
study.
W
hen
pressure
is
applied, the film turns an
intense
pink
color. After lower extremity surgery is performed patients are placed in a short leg plaster splint. The sensor is placed superficial
to the plaster/webril. One sensor is placed beneath both the forefoot and one beneath the hind foot and the splint is then marked
with an “S” to indicate study participation. Once the patient follows up, either the attending physician or a certified cast technician
will retrieve the sensors for documentation. An additional sensor is placed on a non-weight bearing portion of the
anterior tibia to serve as a control. After retrieval of sensors, results are analyzed by at least 4 team members to decide on WB
compliance. Pink coloration of 30% or more is considered positive in our study.
Results: At the time o
f
this abstract, 25 patients had
returned
fo
r
follow
up.
22/25
(88%)
patients were found to
have
at
least
1
out of 2 sensors positive. 13/25 (52%) had both forefoot and hind foot sensors positive. 3 patients had both sensors without any
pressure changes. 5 patients had lost at least 1 sensor.
Conclusion: To date, 88% o
f
ou
r
patients have been
found
t
o
be
non-compliant
w
ith
t
hei
r
w
eight bearing status
instructions.
The
results of this study agree with previous studies demonstrating a high rate of non-compliance even after education and instruction.
Our study exhibited a higher rate of non-compliance when compared to other studies, possibly due to patient demographics.
More data is needed to ascertain the effect of certain risk factors in order to identify the proper method of patient
education/instruction and to possibly create a standardized weight bearing compliance educational program.
Foot & Ankle Orthopaedics, 1(1)
DOI: 10.1177/ 2473011416S00089
©The Author(s) 2016
This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License
(http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original
author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For reprints and permission queries, please visit
SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
Article
Intra-articular calcaneal fractures represent an ongoing challenge for the orthopedic community, with the benefits of the previous “gold standard” treatment of open reduction and internal fixation having been called into question in several large randomized controlled trials. Fine wire circular fixation may represent a useful alternative treatment for these injuries, combining minimally invasive application with rigid fixation, which allows the possibility of early weight bearing We performed a systematic review of published studies that used circular fixation for calcaneal fractures and recorded functional outcomes at follow-up. In a total of 11 studies with 255 calcaneal fractures for which there was follow-up, our inclusion criteria were met: 8.2% of fractures were bilateral, 11.9% of fractures were open fractures, and 12.6% of patients had multiple orthopedic injuries. Functional outcomes were assessed with the use of a variety of tools across the different studies, but outcomes compared favorably with those seen with open reduction and internal fixation. Although pin site infections were common (22.6%), serious complications, including deep infection (0.8%), wound infection (1.6%), and complex regional pain syndrome (0.8%), were exceedingly rare. The results suggest that this is a viable alternative treatment for calcaneal fractures, but higher-quality randomized controlled trials are required before the technique can enter mainstream use.
ResearchGate has not been able to resolve any references for this publication.