scholarly journals Is Immediate Weight Bearing Safe for Lateral Malleolus Fracture after Surgery?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0016
Author(s):  
Young Rak Choi ◽  
Sang-June Lee ◽  
Jaehyung Lee ◽  
Seung-Hwan Park
Keyword(s):  
Return To Work ◽  
Weight Bearing ◽  
Lateral Malleolus ◽  
Initiation Point ◽  
Rehabilitation Protocol ◽  
Ankle Motion ◽  
Significant Difference ◽  
Rehabilitation Protocols ◽  
Motion Exercise ◽  
Hospital Stays

Category: Trauma; Ankle Introduction/Purpose: Isolated lateral malleolus fracture is one of the most common fractures. However, there is controversy regarding the rehabilitation protocols used after surgery. In particular, the initiation point for the weight bearing has not been standardized. In the present study, we investigated the prognostic difference between the immediate and delayed weight bearing on isolated lateral malleolus fractures. Methods: Retrospectively, the medical records of matched 50 and 41patients in the immediate and delayed weight-bearing groups were reviewed. All patients were treated with open reduction and internal fixation using an anatomical locking compression plate. In the immediate weight-bearing group (IWB), tolerable weight bearing (i.e., that can be endured immediately after surgery with crutches) was permitted. In the delayed weight-bearing group (DWB), weight bearing was completely restricted for 4 weeks after surgery. Ankle motion exercise were permitted in both groups since postoperative day. Radiographic assessment data and the clinical outcomes were reviewed. Results: There were no significant differences noted in the radiographic assessments and complications between the two groups. Significant differences of shortening the return to work and hospital stays of IWB rehabilitation protocol were confirmed(5.7 vs. 8.0 days, 6.0 vs. 8.0 days in the IBW and DWB groups, respectively). In FAOS, there was a significant difference in the sport factor evaluated at postoperative 3 months(75.5 vs 68.5, respectively). Conclusion: There were no significant differences between the two groups in the postoperative radiological outcome and complications. And benefits of shortening the return to work and hospital stays of IWB rehabilitation protocol were confirmed. Conclusively, immediate weight bearing is recommended in patients with isolated lateral malleolus fracture, following anatomical reduction and firm fixation through surgery.

scholarly journals Is immediate weight bearing safe for lateral malleolus fracture after surgery?

2020 ◽  
Author(s):  
Sang-June Lee ◽  
Young Rak Choi ◽  
SeongJu Choi ◽  
Ho Seong Lee ◽  
Seung-Hwan Park
Keyword(s):  
Return To Work ◽  
Hospital Stay ◽  
Weight Bearing ◽  
Length Of Hospital Stay ◽  
Lateral Malleolus ◽  
Initiation Point ◽  
Rehabilitation Protocol ◽  
Ankle Motion ◽  
Significant Difference ◽  
Motion Exercise

Abstract Introduction Lateral malleolus fracture is one of the most common fractures. However, there is controversy regarding the rehabilitation protocols used after surgery. In particular, the initiation point for weight bearing has not been standardized. In the present study, we investigated the prognostic difference between immediate and delayed weight bearing on lateral malleolus fractures. Materials and Methods The medical records of matched 50 and 41 patients in the immediate and delayed weight-bearing groups were reviewed retrospectively. All patients were treated with open reduction and internal fixation using an anatomical locking compression plate. In the immediate weight-bearing group (IWB), tolerable weight bearing (i.e., can be endured immediately after surgery with crutches) was permitted. In the delayed weight-bearing group (DWB), weight bearing was completely restricted for 4 weeks after surgery. Ankle motion exercise was permitted in both groups starting from the day after surgery. Radiographic assessment data and clinical outcomes were reviewed. Results No significant differences in the radiographic assessments and complications were found between the two groups. Significant differences in shortened length of hospital stay and time to return to work with the IWB rehabilitation protocol were confirmed (IWB group vs. DWB group: 5.7 vs. 8.0 days and 6.0 vs. 8.0 months, respectively). A significant difference in sport factor was observed in the Foot and Ankle Outcome Score at 3 months postoperatively (75.5 vs 68.5). Conclusions We found no significant differences between the two groups with respect to postoperative radiological outcome and complications. The benefits of shortening the time to return to work and length of hospital stay associated with the IWB rehabilitation protocol were confirmed. In conclusion, immediate weight bearing is recommended in patients with lateral malleolus fracture after anatomical reduction and firm fixation by surgery.

scholarly journals Clinical and Radiographic Outcomes of 3D Printed Total Talus Arthroplasty

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0037
Author(s):  
Daniel Scott ◽  
John Steele ◽  
Amanda Fletcher ◽  
Selene Parekh
Keyword(s):  
Avascular Necrosis ◽  
Weight Bearing ◽  
Treatment Options ◽  
Ankle Motion ◽  
Motion Data ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
3D Printed ◽  
Vas Scores

Category: Ankle, Ankle Arthritis, Hindfoot, Trauma Introduction/Purpose: Patients with talar avascular necrosis have limited treatment options to manage their symptoms. Historically, surgical options have been limited and can leave patients with little ankle motion and have high failure rates. The use of custom 3D printed total talar replacements (TTR) has arisen as a treatment option for these patients, possibly allowing for better preservation of hind-foot motion. Patients undergoing TTR will demonstrate a statistically significant improvement in FAOS scores at one year after surgery. Methods: We retrospectively reviewed 15 patients who underwent a TTR over 2 years. Patient outcomes were reviewed including age, sex, comorbidities, etiology of talar pathology, number and type of prior surgeries, pre-operative and post-operative weight bearing radiographs, as well as FAOS and VAS scores, and range of motion. Data analysis performed with student T-test and multivariate regression. Results: Results: FAOS scores showed statistically significant improvements post-operatively as compared to pre-operative scores. There was a statistically significant decrease in VAS pain scores from 7.0 pre-operatively to 3.4 post operatively. There was no significant difference in pre-operative and post-operative coronal and sagittal alignment on weight bearing radiographs. All FAOS sub-score shows statistically significant improvements, with the exception of the sports/recreation sub-scale, did show a trend towards improved outcomes (p =0.19). Average follow-up was 12.8 months. Conclusion: Our hypothesis was confirmed that these patients show statistically significant improvements in AOFS and VAS scores at 1 year. Sagittal and coronal alignment was well maintained at an average of 1 year following surgery. TTR represents an exciting treatment options for patients with talar avascular necrosis, though longer-term follow-up is needed.

scholarly journals Effect of CAM boot immobilization on weightbearing stability in syndesmotic injuries

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0030
Author(s):  
Stéphanie Lamer ◽  
Vincent Dube ◽  
Jonah Hebert-Davies ◽  
Leduc Stephane ◽  
Jeremie Menard ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Weight Bearing ◽  
Axial Loading ◽  
Nonoperative Treatment ◽  
Ankle Injuries ◽  
Ligament Injury ◽  
Ankle Motion ◽  
Parametric Data ◽  
Custom Made ◽  
Significant Difference

Category: Trauma Introduction/Purpose: Ankle injuries are one of the most frequent traumas of the lower limb. They typically involve the lower lateral ligaments of the ankle, but the syndesmosis is also affected in up to 18% of cases. The degree of instability of syndesmotic joint depends on which ligaments are affected. Adequate management of syndesmotic injuries is crucial to avoid long term complications. The primary goal of our study was to evaluate the effect of simulated weightbearing on syndesmotic instability resulting from isolated AiTFL injury and from combined AiTFL/IOL injuries. The secondary goal was to evaluate the effect of a controlled ankle motion walking boot on syndesmosis stability following injury. We hypothesized that the CAM boot would prevent significant instability even in two ligaments injuries. Methods: Ten cadaveric specimens were dissected to expose the syndesmosis to create progressive iatrogenic syndesmosis ruptures. Uninjured syndesmoses were compared to isolated AiTFL and combined AiTFL/IOL ruptures. The specimens were fitted in a custom-made device to allow stabilization of the leg and apply a reproducible axial load (AL) of 750 N, equivalent to the weight of a 168-pound person. For each specimen and injury pattern, CT-scan images were obtained with and without AL, and with a CAM boot under AL. Distal tibio-fibular relationship was evaluated in three planes using a previously validated measurement system developed on CT. Wilcoxon tests for paired samples and non-parametric data were done to compare the different conditions. Results: For our first objective, when comparing ankles with isolated AiTFL to combined AiTFL/IOL rupture with and without AL, the only significant difference was an increase in internal rotation between the incisura and a line drawn in the axis of the fibula. Even with minimal statistical differences, it appears that axial loading does not impact syndesmotic stability apart from a slight increase in internal rotation with a single or two-ligament injury. As for our second end point, with the CAM orthopedic boot, no significant widening of the syndesmosis happened when either one or both ligaments were sectioned, in an axial loading state. We therefore confirmed our hypothesis that even with two syndesmotic ligament injuries, axial loading in a CAM boot does not affect distal tibio-fibular anatomy. Conclusion: This study reveals that weight bearing without rotational force does not affect the stability of the syndesmosis. Incomplete syndesmotic injuries can likely be treated with nonoperative treatment in a CAM boot and weight bearing as tolerated. Further clinical studies are needed to confirm these findings.

scholarly journals Rehabilitation following meniscal repair: a systematic review

2018 ◽  
Vol 4 (1) ◽  
pp. e000212 ◽  
Author(s):  
Robert C Spang III ◽  
Michael C Nasr ◽  
Amin Mohamadi ◽  
Joseph P DeAngelis ◽  
Ara Nazarian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Range Of Motion ◽  
Clinical Studies ◽  
Weight Bearing ◽  
Meniscal Repair ◽  
Rehabilitation Protocol ◽  
Early Motion ◽  
Accelerated Rehabilitation ◽  
Rehabilitation Protocols ◽  
Meta Analyses

ObjectiveTo review existing biomechanical and clinical evidence regarding postoperative weight-bearing and range of motion restrictions for patients following meniscal repair surgery.Methods and data sourcesFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, we searched MEDLINE using following search strategy: ((((“Weight-Bearing/physiology”[Mesh]) OR “Range of Motion, Articular”[Mesh]) OR “Rehabilitation”[Mesh])) AND (“Menisci, Tibial”[Mesh]). Additional articles were derived from previous reviews. Eligible studies were published in English and reported a rehabilitation protocol following meniscal repair on human. We summarised rehabilitation protocols and patients’ outcome among original studies.ResultsSeventeen clinical studies were included in this systematic review. There was wide variation in rehabilitation protocols among clinical studies. Biomechanical evidence from small cadaveric studies suggests that higher degrees of knee flexion and weight-bearing may be safe following meniscal repair and may not compromise the repair. An accelerated protocol with immediate weight-bearing at tolerance and early motion to non-weight-bearing with immobilising up to 6 weeks postoperatively is reported. Accelerated rehabilitation protocols are not associated with higher failure rates following meniscal repair.ConclusionsThere is a lack of consensus regarding the optimal postoperative protocol following meniscal repair. Small clinical studies support rehabilitation protocols that allow early motion. Additional studies are needed to better clarify the interplay between tear type, repair method and optimal rehabilitation protocol.

scholarly journals Using a self-rehabilitation application alone can effectively combat post-ACL ligament reconstruction flexion contracture during the COVID-19 lockdown

2021 ◽  
Vol 9 (2_suppl) ◽  
pp. 2325967121S0001
Author(s):  
Jean Marie Fayard ◽  
Maxime Tatar ◽  
Mathieu Thaunat ◽  
Bertrand Sonnery-Cottet ◽  
Benjamin Freychet ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Physical Therapist ◽  
Weight Bearing ◽  
Group Versus ◽  
Flexion Contracture ◽  
Rehabilitation Protocol ◽  
Flexion Contractures ◽  
Acl Surgery ◽  
Significant Difference

Objectives: The lockdown during the COVID-19 crisis deprived the majority of patients who had undergone ACL surgery of access to their physical therapist. The objective of the study was to analyze the benefit of using a self-rehabilitation application to combat post-ligament reconstruction flexion contracture in the absence of rehabilitation during the lockdown. Methods: We conducted a retrospective study that compared 2 groups of patients who had undergone ACL reconstruction: the "App" group that underwent surgery between 10 February and 15 March 2020 were partially or totally deprived of access to a physiotherapist due to the COVID-19 lockdown and had completed rehabilitation using a self-rehabilitation application, and the "Physio" group that underwent surgery between 16 May and 23 December 2019 and had completed rehabilitation with a physiotherapist. Results: 148 patients were included in the study: 47 in the "App" group and 101 in the "Physio" group. Mean flexion contracture 3 weeks postoperatively was 1.3° +/- 3.8 in the "App" group versus 3.3° +/- 4 in the "Physio" group (p=0.002). The rate of flexion contractures was 45% in the “App” group and 65% in the “Physio” group (p=0.025). 71.4% of the patients acquired knee locking on weight-bearing with crutches in the "App" group, compared to 40.6% in the "Physio" group (p<0.01). No significant difference was noted between the two groups concerning the degree and rate of flexion contractures 6 weeks postoperatively and quadriceps recovery at 3 and 6 weeks postoperatively. Conclusion: Our study showed that the use of a self-rehabilitation application that targets flexion contracture control and quadriceps recovery in the first 6 weeks after ACL reconstruction provides similar results to a rehabilitation protocol by an independent physiotherapist.

scholarly journals Short-stem total hip arthroplasty is not associated with an earlier return to work compared to a straight-stem design

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Georg Hauer ◽  
Maria Smolle ◽  
Sabrina Zaussinger ◽  
Joerg Friesenbichler ◽  
Andreas Leithner ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Sick Leave ◽  
Return To Work ◽  
Hip Arthroplasty ◽  
Short Stem ◽  
Multivariate Linear Regression Analysis ◽  
Stem Design ◽  
Total Hip ◽  
Straight Stem ◽  
Significant Difference

AbstractReturn to work (RTW) has been specifically identified as a high priority in patients undergoing total hip arthroplasty (THA). This investigation sought to assess the effect of the stem design on patients’ RTW. Secondly, the study aimed to identify risk factors that lead to a delayed RTW. Questionnaires inquiring about RTW, employment history, educational level, type of work, physical demands and joint awareness were administered by post. Further data were collected from patients’ hospital records. 176 patients who underwent THA using a short-stem and 97 patients using a straight-stem design were compared. The median return to work time was 10 weeks [IQR 7–14 weeks], with no significant difference between the two groups (short stems vs. straight stems; 10 [IQR 7–14] vs. 11 [7.5–13.5] weeks; p = 0.693). In the multivariate linear regression analysis, self-employment vs. employee (p = 0.001), dimension of preoperative workload (p = 0.001), preoperative sick leave (p < 0.001), and hospital length of stay (LOS) (p < 0.001) independently affected the period until work was resumed. The Forgotten-Joint-Score-12 showed no significant difference between the two groups. The data show that the majority of THA patients can expect to resume work and stem design has no impact on RTW. Employees with preoperative sick leave, prolonged hospital LOS and low workload are at higher risk for a delayed RTW.

Microfracture for the Treatment of Symptomatic Cartilage Lesions of the Knee: A Survey of International Cartilage Regeneration & Joint Preservation Society

Cartilage ◽  
2020 ◽  
pp. 194760352095450
Author(s):  
Jesus Medina ◽  
Ignacio Garcia-Mansilla ◽  
Peter D. Fabricant ◽  
Thomas J. Kremen ◽  
Seth L. Sherman ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Regional Differences ◽  
Current Practice ◽  
Cartilage Regeneration ◽  
Postoperative Management ◽  
Cartilage Lesions ◽  
Significant Difference ◽  
Rehabilitation Protocols ◽  
Joint Repair ◽  
Vertical Walls

Objective The purpose of this study was to describe the current practice trends for managing symptomatic cartilage lesions of the knee with microfracture among ICRS (International Cartilage Regeneration & Joint Repair Society) members. Design A 42-item electronic questionnaire was sent to all ICRS members, which explored indications, surgical technique, postoperative management, and outcomes of the microfracture procedure for the treatment of symptomatic, full thickness chondral and osteochondral defects of the knee. Responses were compared between surgeons from different regions and years of practice. Results A total of 385 surgeons answered the questionnaire. There was a significant difference noted in the use of microfracture among surgeons by region ( P < 0.001). There was no association between the number of years in practice and the self-reported proportion of microfracture cases performed ( P = 0.37). Fifty-eight subjects (15%) indicated that they do not perform microfracture at all. Regarding indication for surgery, 56% of surgeons would limit their indication of microfracture to lesions measuring 2 cm2 or less. Half of the surgeons reported no upper age or body mass index limit. Regarding surgical technique, 90% of surgeons would recommend a formal debridement of the calcified layer and 91% believe it is important to create stable vertical walls. Overall, 47% of surgeons use biologic augmentation, with no significant difference between regions ( P = 0.35) or years of practice ( P = 0.67). Rehabilitation protocols varied widely among surgeons. Conclusions Indications, operative technique, and rehabilitation protocols utilized for patients undergoing microfracture procedures vary widely among ICRS members. Regional differences and resources likely contribute to these practice pattern variations.

Pancreaticogastrostomy after Pancreaticoduodenectomy Using Twin Square Wrapping with Duct-to-Mucosa Anastomosis

2015 ◽  
Vol 55 (1-2) ◽  
pp. 109-118 ◽  
Author(s):  
Kosei Maemura ◽  
Yuko Mataki ◽  
Hiroshi Kurahara ◽  
Shinichiro Mori ◽  
Naotomo Higo ◽  
...  
Keyword(s):  
Operating Time ◽  
Conventional Group ◽  
C Reactive Protein ◽  
Pancreatic Anastomosis ◽  
Pancreatic Stump ◽  
Reactive Protein ◽  
Significant Difference ◽  
Pancreatic Fistulas ◽  
Hospital Stays ◽  
Blood Loss Volume

Background/Purpose: This study aimed to evaluate the feasibility and safety of a novel pancreaticogastrostomy technique for diminishing pancreatic fistulas after pancreaticoduodenectomy using gastric wrapping of the pancreatic stump with a twin square-shaped horizontal mattress and a suture fixing the main pancreatic duct to the gastric mucosa anastomosis [twin square wrapping (TSW) method]. Methods: Fifty-three patients undergoing pancreaticogastrostomy after pancreaticoduodenectomy were included in the study and chronologically divided into a conventional group (n = 32) and a TSW group (n = 21). The perioperative factors and the postoperative outcomes were retrospectively analyzed. Results: The operating time for the pancreatic anastomosis, the total operating time, and the blood loss volume in the TSW group were lower than in the conventional group, but without a statistically significant difference. The TSW group had a significantly lower postoperative white blood cell count and C-reactive protein level, with a reduced intra-abdominal fluid accumulation as assessed by computed tomography on postoperative day 7, had a lower incidence of postoperative complications and pancreatic fistulas, and achieved a shorter duration of drain placement and shorter postoperative hospital stays as compared to the conventional group. Conclusions: The TSW technique should be considered for reducing pancreatic fistulas by diminishing the postoperative inflammatory response and improving patient outcomes without increasing the operating time.

Continuous Femoral Nerve Blockade versus Continuous Epidural Analgesia for Postoperative Pain Relief in Knee Surgeries

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hala Gomaa Salama ◽  
Ahmed Ali El- Shebiny ◽  
Abd Al Aziz Abdullah Abd Al Aziz ◽  
Mariam Mahmoud Ahmed Ali Shehata
Keyword(s):  
Postoperative Pain ◽  
Epidural Analgesia ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Weight Bearing ◽  
Femoral Nerve ◽  
Disease Process ◽  
Continuous Epidural Analgesia ◽  
Significant Difference ◽  
Continuous Femoral Nerve Block

Abstract Background The progression of osteoarthritis is characteristically slow, occurring over several years or decades. Over this period, the patient can become less and less active and thus more susceptible to morbidities related to decreasing physical activity (including potential weight gain). Early in the disease process, the joints may appear normal. However, the patient’s gait may be antalgic if weight-bearing joints are involved. Objective Compare the benefits of continuous femoral nerve block (CFNB) with those of continuous epidural analgesia CEPA for postoperative pain management after Knee surgeries. Methods This study is a randomized controlled clinical trial was conducted in Ain Shams University Hospitals after obtaining approval from the Research Ethical Committee of Ain Shams University during a period of three months. Patients undergoing primary unilateral TKA for osteoarthritis, were recruited at least one day prior to the scheduled surgery, male and female patients. Results There was significant difference in terms of pain scoring between continuous femoral nerve block (CFNB) and continuous epidural analgesia (CEA) in the first 6 hours, 12 hours, 24 hours, 48 hours, 72 hours but non significant difference in incidence of side effects Conclusion Our study showed that CEA had optimal analgesia and pain control than CFNB in management of post operative pain after total knee replacement.

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