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Table II. Baseline characteristics of total sample
Characteristics Total n  = 150
Female, n (%)
Age, years, median (IQR)[min–max]
≥2 fractures, n (%)
Head injury, n (%)
Fracture type, n (%) 47 (31.3)
48 (33.0, 57.0)[15–77]
124 (82.7)
19 (12.7)
Pelvic/acetabular 76 (37.8)
Distal femur 42 (20.9)
Tibial plateau 31 (15.4)
Distal tibia/ankle 31 (15.4)
Baseline characteristics
201
IQR: interquartile range.
In case of limited conditional abilities, such as lack of joint
mobility, muscle strength, joint stability, endurance and/or pos-
tural balance, trade-offs have to be made regarding the above
items. The patient will have to give a priority as to which of the
above aspects are most important to them.
Pilot study
In order to assess the level of weight-bearing and the rate of
complications when using the PROMETHEUS protocol, a
pilot study was conducted in 2015, which included surgically
treated trauma patients with (peri)- or intra-articular fractures
of the pelvis and lower extremities who were admitted to our
rehabilitation centre between 2005 and 2015.
Patients with pathological fractures, shaft fractures treated
with intra-medullary nailing, or fractures treated with external
fixation, and patients with amputations in the area of the lower
extremity, were excluded. Also excluded were patients with
cognitive dysfunction, due to the consequences of a severe
neurotrauma or to concomitant or drug-based mental illness.
All data in the study were collected retrospectively from the
electronic patient records, by 1 researcher. Demographics of
patients retrieved included age, sex, date of accident, type of
fracture and type of fixation.
Primary outcome measures included the time from surgery till
full weight-bearing and the total number and type of complica-
tions at 1-year follow-up. Type of complications were defined
separately, comprising adverse events that occurred during 1
year of the PWB regime. The rate of individual complications
was also recorded.
The medical ethics committee approved this study, and in-
formed consent was given by all patients.
Statistical analysis
Statistical analysis was performed with IBM SPSS Statistics,
Version 23.0, Armonk, New York. Descriptive statistics were
used to describe the demographic data and baseline characte-
This pilot study included 150 patients, of whom 69%
were male, with a median age of 48 years ([IQR 33.0,
57.0], [15–77] years). The sample included different
types of surgically treated (peri)- or intra-articular frac-
tures of the pelvis and lower extremities from the pelvis
to the foot. Baseline characteristics are shown in Table
II. In all, n = 124 (82.7%) of the patients had 2 or more
fractures, and n = 19 patients (12.7%) had head injuries.
In total, 201 lower extremity fractures were identified,
which can be divided into 5 subtypes: pelvic/acetabular
(n = 76), distal femoral metaphysis or (peri-)articular
distal femur (n = 42), tibial plateau (n = 31), distal tibia/
ankle (n = 31), and foot (talus, calcaneus) (n = 21).
Process outcome measures
The median time from fracture surgery to the start of
PWB was 2.0 weeks ([IQR 2.0, 3.25], [0–9] weeks).
Fifty-two percent of the patients (n = 78) reached full
weight-bearing within 12 weeks. The median time to
full weight-bearing was 12.0 weeks ([IQR 6.82, 19.18],
[2–52] weeks). Table III specifies for each group of
fractures the median and percentage of patients reach-
ing full weight-bearing.
Patient outcome measures
The complication rate during postoperative rehabilita-
tion was 10.0% (n = 15) of all patients included. Most
complications involved non-unions (n = 5), wound
infections (n = 4) or early removal of implants (n = 3)
because of pain and/or infection. There was one im-
plant failure and no secondary dislocations. The num-
bers and types of complications are shown in Table IV,
specified for each fracture category.
Table III. Time to full weight-bearing for specific fracture types (n = 150)
Time to full weight-bearing, weeks,
median (IQR) [min–max]
RESULTS
21 (10.4)
Foot
Total number of fractures
ristics of the entire population. Results are presented as fre-
quencies and percentages. Data are described as median values,
interquartile ranges [x,y] and the minimum and the maximum
[min–max]. Binary logistic regression was performed to assess
independent predictors of late full weight-bearing (> 12 weeks)
throughout both PWB and RWB groups. The level of statistical
significance was set at α = 0.05.
Pelvic/ acetabular Distal femur
fractures
fractures Tibial plateau
fractures Distal tibia/ankle
fractures
Foot fractures Total population
12.6 (6.0, 18.9)
[2–52] 9.1 (6.0, 17.3)
[3–52] 15.0 (9.7, 20.0)
[2–43] 14.0 (5.7, 24.0)
[3–43] 17.0 (7.0, 24.8)
[3–48] 12.0 (6.8, 19.2)
[2–52]
61.9 45.2 45.2 42.9 52.0
Full weight-bearing within 12 weeks, % 50.0
IQR: interquartile range.
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