DÄ internationalArchive42/2014Contradictory Weight-bearing Recommendations
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Whether all patients selected for conservative treatment should be mobilized in the walker with full weight-bearing needs to be critically discussed. Fracture type, bone quality and the patient’s ability to comply with the demands of the aftercare should all be taken into account.

Here, partial or even no weight-bearing for several weeks may be considered. Irrespective of this, the S3 guideline “Prophylaxis of Venous Thromboembolism” as of June 2010 (1) recommends antithrombotic treatment with low-molecular-weight heparin until removal of the immobilizing cast (= lower-leg walker).

To only provide antithrombotic treatment if full weight-bearing is delayed or based on the form of the fracture does not comply with the guideline. With regard to weight-bearing, the authors make contradictory statements within one and the same paragraph. First, pain-adapted full weight-bearing is recommended. However, in the following sentence, they limit the scope of this recommendation. This point should be clarified.

In the last paragraph “Postoperative treatment and rehabilitation”, the authors recommend to continue antithrombotic treatment until full weight-bearing and full mobilization have been achieved. In the questions section (question 6), the recommendation is specified to the administration of low-molecular-weight heparin in a weight-adapted dose.

Again, this is in conflict with the guideline cited earlier: On page 65 of the guideline, it is recommended to continue antithrombotic treatment until the cast (“walker“) is removed or until partial weight-bearing of 20 kg and a range of motion of 20° in the ankle joint have been achieved. Where necessary, treatment should be continued in the presence of “pre-disposing risk factors“. Furthermore, dosing is rather guided by the surgical risk of thrombosis/postoperative immobilization than by the patient’s body weight.

DOI: 10.3238/arztebl.2014.0721b

Dr. med. Bernd Kottenhahn

Klinikum Landsberg am Lech
Landsberg

bernd.kottenhahn@klinikum-landsberg.de

1.
AWMF S3-Leitlinie zur Prophylaxe der venösen
Thromboembolie (VTE) Stand 6/2010 www.awmf.org/uploads/tx_szleitlinien/003–001l_S3_Thromboembolie-Prophylaxe_ 2010_01.pdf . Last accessed on 21 August 2014.
2.
Goost H, Wimmer MD, Barg A, Kabir K, Valderrabano V, Burger C: Fractures of the ankle joint—investigation and treatment options VOLLTEXT
1.AWMF S3-Leitlinie zur Prophylaxe der venösen
Thromboembolie (VTE) Stand 6/2010 www.awmf.org/uploads/tx_szleitlinien/003–001l_S3_Thromboembolie-Prophylaxe_ 2010_01.pdf . Last accessed on 21 August 2014.
2.Goost H, Wimmer MD, Barg A, Kabir K, Valderrabano V, Burger C: Fractures of the ankle joint—investigation and treatment options VOLLTEXT

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