scholarly journals Impact of Early Rehabilitation in a Complex Case of Non-union of Tibial Plafond Fracture with Osteosynthesis Associated Infection – A Case Report

2021 ◽  
pp. 55-61
Author(s):  
Harsh Nathani ◽  
Medhavi V. Joshi ◽  
Pratik A. Phansopkar
Keyword(s):  
Lower Limb ◽  
Road Traffic ◽  
Exercise Program ◽  
Soft Tissue Injuries ◽  
Rehabilitation Program ◽  
Early Rehabilitation ◽  
Complex Case ◽  
Muscle Properties ◽  
Non Union ◽  
Tibial Plafond

Background: Fractures of distal end of tibia associated with soft tissue injuries and fracture of distal fibular end are very complex and forms a total of 1-2% of all fracture of lower limb. These fractures are widely termed as plafond fractures. Case Presentation: A 26- year-old male, a follow up case, gave a history of road traffic accident following which he underwent corticotomy and application of external Ilizarovring fixator. At present due to non-union of the fracture segments patient got readmitted after a year. Further management through a three-step surgical approach was carried out. Rehabilitation program began from post-operative day 1 and was continued for a period of three weeks. Investigations: On the day of examination, the patient’s pain was severe on movement with presence of disuse trophy of lower limb musculature of the affected extremity. Ranges on the right lower limb at all joints were reduced due to pain. The X-ray showed presence of 9-hole recon plate fixed distally over talus and proximally to tibia. Management: Physiotherapeutic intervention began with educating the patient and the caregivers about the condition, the precautions to be taken, the expected time of healing and extent of healing. The exercise program was based on the principles of variability and individuality. The protocol was changed weekly with the observed progression in the patients range, muscles strength and ability to perform more challenging in bed activities. Conclusion: Early rehabilitation in complex cases of tibial plafond fracture facilitates the process of healing as well as maintain the patients level of functioning by maintain muscle properties. Post-operative complications are also reduced.

scholarly journals Functional outcome of comminuted upper metaphyseal tibial fracture treated with circular external fixators

2021 ◽  
Vol 7 (3) ◽  
pp. 622
Author(s):  
Parth Patel ◽  
Harpreet Singh ◽  
Kamal Kumar Agarwal ◽  
Tilak Patel ◽  
Krushna Saoji ◽  
...  
Keyword(s):  
High Speed ◽  
Tibial Fracture ◽  
Motor Vehicle ◽  
Road Traffic ◽  
Early Mobilization ◽  
Soft Tissue Injuries ◽  
Definitive Treatment ◽  
Invasive Technique ◽  
External Fixators ◽  
Non Union

<p class="abstract"><strong>Background:</strong> High speed motor vehicle accidents are on the rise over the past few years. These are responsible for most of the complex fractures of the tibial metaphysic. Proper treatment of these fractures is of paramount importance. The use of circular fixators for the definitive treatment of such fractures entails a minimally invasive technique of insertion that gives good fracture reduction and stability combined with minimal postoperative complications.</p><p class="abstract"><strong>Methods:</strong> This study was prospective and conducted over 22 patients diagnosed with upper comminuted metaphyseal tibial fracture treated with circular external fixator.</p><p class="abstract"><strong>Results:</strong> In this series, all 22 patients (100%) were male. Fourteen cases (64%) involved the left tibia and eight (36%) fractures were on right. The mean patient age was 49.5 years (range 26-75). Road traffic collisions accounted for most of the injuries (n=14), while fall from bike (n=8). In this study, using knee society score evaluation, excellent results (KSS&gt;80) were seen in 8 patients (36.36%), good results (KSS 70-79) were seen in 10 patients (45.45%), fair (KSS 60-69) in 4 patient (18.18%) and poor (KSS&lt; 60) in 0 patient (0%). Complication seen was pin tract infection in 2 patients (9.9%), which was managed by regular pin site dressings. Another complication was non-union in 1 patient (4.54%). No other complication was encountered.</p><p class="abstract"><strong>Conclusions:</strong> Circular external fixation is a promising modality for surgical treatment of comminuted upper metaphyseal tibial fractures. It allows satisfactory realignment of the fractured fragments and their stabilization, besides early mobilization of the joints and care of associated soft tissue injuries, without significant complications.</p>

scholarly journals Physical therapy management in knee ankylosis -Case study-

2017 ◽  
Vol 10 (19) ◽  
pp. 15-18
Author(s):  
Ana-Maria Vutan
Keyword(s):  
Lower Limb ◽  
Muscular Strength ◽  
Correct Diagnosis ◽  
Exercise Program ◽  
Rehabilitation Program ◽  
Unknown Etiology ◽  
Parental Supervision ◽  
Home Program ◽  
Short Time

Abstract Aim: The purpose of this paper is to present a complicated case of a 2.8 year-old child with knee synovitis of unknown etiology which complicated in a very short time by the appearance of an ankylosis. The removal of the cast after 3 weeks revealed stiffness in flexion of the affected knee. Neither physiotherapy nor attempts to mobilize under anesthesia, led to the expected results. Consequently, the patient was referred to a surgery service for the adherence removal by arthrotomy. During the following 5 months, new complications developed due to a double tibia and peroneal fracture. After the consolidation of the fractures, both the therapist and the recovery protocol were changed. Method: For one and a half years, the child followed two weekly recovery sessions consisting in physiotherapy and massage. At home the child did an exercise program under parental supervision and worn an orthosis. Results: At the end of the rehabilitation program we noticed the restoring the normal amplitude of all the lower limb joints, restoring the muscular strength of the lower limb, and normal course resumption. Conclusion: In addition to the need for a correct diagnosis of the disease, such cases also require an adequate recovery protocol, following the instructions given by the treating physician and to ensure continuity of the rehabilitation program (both in a recovery and home program), until the complete rehabilitation of the deficit.

Progressive Early Rehabilitation Program Applied to Patients with Acute Cerebrovascular Accident

2020 ◽  
Vol 25 (3) ◽  
pp. 17-25 ◽  
Author(s):  
G. R. Ramazanov ◽  
L. B. Zavaliy ◽  
L. L. Semenov ◽  
S. A. Abudeev ◽  
A. O. Ptitsyn ◽  
...  
Keyword(s):  
Cerebrovascular Accident ◽  
Lung Ventilation ◽  
Rehabilitation Program ◽  
Artificial Lung ◽  
Early Rehabilitation ◽  
Gravity Gradient ◽  
Acute Cerebrovascular Accident ◽  
Artificial Lung Ventilation ◽  
Bed Days ◽  
Severity Of The Disease

Abstract. Early rehabilitation (ER) of patients with acute cerebrovascular accident (ACA) is one of the priority tasks of the vascular centers; the issue of increasing the volume of rehabilitation measures in the resuscitation and intensive care units (ICU) is relevant. Objective. To evaluate the safety and effectiveness of the progressive ER program in patients with ACA. Material and research methods. The study included 129 patients with ACA in ICU. Each patient of the main group (MGr, n = 61) underwent progressive ER: at least 4–5 vertical adjustments per day, passive mode Kinesiotherapy 49 ± 9.3 minutes, a double load of physiotherapy exercises, preventive physiotherapy; the total time of classes reached 240 minutes per day. In the comparison group (СGr, n = 68), standard ER was performed no more than 120 minutes per day. The groups are comparable by sex, age, severity of the disease and comorbidity. The severity of ACA, the gravity gradient, patient mobility, functional status, degree of dependence, and the presence of complications were evaluated. Results. During a month of work with the MGr, 102 ICU bed-days, 94 days of the artificial lung ventilation use, p < 0.05 were saved. Mortality in MGr decreased -— 8 patients (13.1%) versus 14 (20.6%) in CGr (p < 0.05). In patients within CGr, pulmonary thromboembolism developed in 8.8%, in MGr – in 3.3%. The severity of the apoplectic attack decreased ( by 28% in MGr, and by 20% in CGr ), mobility increased. Comparing the modalities of post resuscitationsyndrome in MGr, it was noted that the score decreased by 2 times from 6 [5; 6] to 3 [2.3; 3.3], but it has not changed in the CGr. Patients in the MGr were 2-–3 days earlier adapted to the vertical adjustment. Conclusions. The progressive ER program in ICU is safe, effective, realisable, and allows reducing the number of bed-days in ICU, the number of days of the artificial lung ventilation use, complications, and mortality in comparison with standard medical care.

scholarly journals Role and effectiveness of complex and supervised rehabilitation on overall and hand function in systemic sclerosis patients—one-year follow-up study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Michał Waszczykowski ◽  
Bożena Dziankowska-Bartkowiak ◽  
Michał Podgórski ◽  
Jarosław Fabiś ◽  
Arleta Waszczykowska
Keyword(s):  
Systemic Sclerosis ◽  
Hand Function ◽  
Exercise Program ◽  
Rehabilitation Program ◽  
Long Term Results ◽  
Home Exercise ◽  
Control Group ◽  
Study Group

AbstractThe aim of this study was to estimate the long-term results of complex and supervised rehabilitation of the hands in systemic sclerosis (SSc) patients. Fifty-one patients were enrolled in this study: 27 patients (study group) were treated with a 4-week complex, supervised rehabilitation protocol. The control group of 24 patients was prescribed a home exercise program alone. Both groups were evaluated at baseline and after 1-, 3-, 6-, and 12-months of follow-up with the Disability of the Arm, Shoulder and Hand Questionnaire (DAHS) as the primary outcome, pain (VAS—visual analog scale), Cochin Hand Function Scale (CHFS), Health Assessment Questionnaire Disability Index (HAQ-DI), Scleroderma-HAQ (SHAQ), range of motion (d-FTP—delta finger to palm, Kapandji finger opposition test) and hand grip and pinch as the secondary outcomes. Only the study group showed significant improvements in the DASH, VAS, CHFS and SHAQ after 1, 3 and 6 months of follow-up (P = 0.0001). Additionally, moderate correlations between the DASH, CHFS and SHAQ (R = 0.7203; R = 0.6788; P = 0.0001) were found. Complex, supervised rehabilitation improves hand and overall function in SSc patients up to 6 months after the treatment but not in the long term. The regular repetition of this rehabilitation program should be recommended every 3–6 months to maintain better hand and overall function.

scholarly journals Effects of Neuromuscular Electrical Stimulation Combined with Exercises versus an Exercise Program on the Physical Characteristics and Functions of the Elderly: A Randomized Controlled Trial

2021 ◽  
Vol 18 (5) ◽  
pp. 2463
Author(s):  
Eun Mi Jang ◽  
So Hyun Park
Keyword(s):  
Electrical Stimulation ◽  
Muscle Mass ◽  
Lower Limb ◽  
Neuromuscular Electrical Stimulation ◽  
Exercise Program ◽  
The Elderly ◽  
Exercise Group ◽  
Low Intensity ◽  
Strengthening Exercise ◽  
Low Intensity Exercise

(1) Background—The application of neuromuscular electrical stimulation (NMES) combined with low-intensity exercise to the elderly can be more efficient than low-intensity exercise only in terms of delaying the loss of muscle mass. We aimed to assess the adjunct of NMES to low-intensity lower limb strengthening exercise to prevent falls in frail elderly for a relatively short period of 4 weeks. (2) Methods—Thirty elderly women aged 65 or above were randomly categorized into three groups: control group (CON, n = 8), exercise group (EX, n = 10), and NMES with exercise group (EX + NMES, n = 9). The exercise group took part in a lower limb strengthening exercise program for one hour three times a week for four weeks. Furthermore, the NMES with exercise group had added NMES stimulation when exercising. The limbs’ muscle mass, body fat mass, calf circumference, grip force, five times sit-to-stand test, timed up-and-go test (TUG), one-leg stand test, and Y-balance test (YBT) were evaluated at baseline and 4 weeks after. (3) Results—Comparisons between the three groups showed that the TUG was significantly decreased and the YB was significantly increased in NMES with exercise group (p < 0.05). (4) Conclusions—These results suggested that a combination of NMES stimulation and exercises was more helpful in strengthening balance than exercises alone in the short term.

Effects of a motor imagery-based exercise protocol on chronic pain and emotional distress in patients with fibromyalgia syndrome: A pilot study

2021 ◽  
pp. 1-10
Author(s):  
Teresa Paolucci ◽  
Francesco Agostini ◽  
Massimiliano Mangone ◽  
Andrea Torquati ◽  
Simona Scienza ◽  
...  
Keyword(s):  
Motor Imagery ◽  
Fibromyalgia Syndrome ◽  
Coping Behavior ◽  
Exercise Program ◽  
Rehabilitation Program ◽  
The Body ◽  
Control Group ◽  
Exercise Protocol ◽  
And Coping

BACKGROUND: Fibromyalgia (FM) is a chronic condition characterized by widespread muscular or musculoskeletal pain of at least 3 months’ duration, occurring above and below the waist, on both sides of the body. OBJECTIVE: The aim of this study was to evaluate the effectiveness of a rehabilitation program based on motor imagery versus a conventional exercise program in FM in terms of pain, functional and psychological outcomes. METHODS: Twenty-nine female subjects were randomly assigned to a group receiving motor imagery-based rehabilitation (MIG) or to a control group (CG) performing conventional rehabilitation. Outcome assessments were performed before (T0) and after 10 sessions of treatment (T1) and at a 12-week follow-up (T2). Pain, function and psychological measurements were conducted by means of different questionnaires. RESULTS: Both treatments improved all outcomes at post-treatment (T1) and follow-up (T2). The MIG showed a significant improvement in anxiety disorder associated with FM with respect to the CG, as well as improvements in coping strategies. CONCLUSIONS: Rehabilitation treatment based on motor imagery showed a stronger effect on anxiety and coping behavior than traditional physiotherapy in patients with FM. Integrated psychological support would be desirable in this setting. Further research is needed to explore the aspects investigated in more depth.

scholarly journals Peripheral Blood T Cell Gene Expression Responses to Exercise and HMB in Sarcopenia

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2313
Author(s):  
Suk-Ling Ma ◽  
Junyi Wu ◽  
Liuying Zhu ◽  
Ruth Chan ◽  
Amy Wang ◽  
...  
Keyword(s):  
Gene Expression ◽  
T Cell ◽  
Lower Limb ◽  
Exercise Program ◽  
Lower Limb Muscle ◽  
Limb Muscle ◽  
Strength Performance ◽  
Leg Extension ◽  
Cell Gene Expression ◽  
Cell Gene

Background: Sarcopenia is a major health problem in older adults. Exercise and nutrient supplementation have been shown to be effective interventions but there are limited studies to investigate their effects on the management of sarcopenia and its possible underlying mechanisms. Here, we studied T cell gene expression responses to interventions in sarcopenia. Methods: The results of this study were part of a completed trial examining the effectiveness of a 12-week intervention with exercise and nutrition supplementation in community-dwelling Chinese older adults with sarcopenia, based on the available blood samples at baseline and 12 weeks from 46 randomized participants from three study groups, namely: exercise program alone (n = 11), combined-exercise program and nutrition supplement (n = 23), and waitlist control group (n = 12). T cell gene expression was evaluated, with emphasis on inflammation-related genes. Real-time PCR (RT-PCR) was performed on CD3 T cells in 38 selected genes. Correlation analysis was performed to relate the results of gene expression analysis with lower limb muscle strength performance, measured using leg extension tests. Results: Our results showed a significant improvement in leg extension for both the exercise program alone and the combined groups (p < 0.001). Nine genes showed significant pre- and post-difference in gene expression over 12 weeks of intervention in the combined group. Seven genes (RASGRP1, BIN1, LEF1, ANXA6, IL-7R, LRRN3, and PRKCQ) showed an interaction effect between intervention and gene expression levels on leg extension in the confirmatory analysis, with confounder variables controlled and FDR correction. Conclusions: Our findings showed that T cell-specific inflammatory gene expression was changed significantly after 12 weeks of intervention with combined exercise and HMB supplementation in sarcopenia, and that this was associated with lower limb muscle strength performance.

The Lower Limb Amputee Measurement Scale: Reliability and predictive validity

2007 ◽  
Vol 31 (3) ◽  
pp. 300-312 ◽  
Author(s):  
Oren Cheifetz ◽  
Mark Bayley ◽  
Sharon Grad ◽  
Debbie Lambert ◽  
Cass Watson ◽  
...  
Keyword(s):  
Predictive Validity ◽  
Lower Limb ◽  
Assessment Tool ◽  
Pearson Correlation ◽  
Rehabilitation Program ◽  
Measurement Scale ◽  
Initial Assessment ◽  
Team Members ◽  
Scale Reliability ◽  
Lower Limb Amputee

This study assesses the reliability and predictive validity of the Lower Limb Extremity Amputee Measurement Scale (LLAMS), which is an assessment tool designed to predict the length of stay (LOS) of patients with lower limb amputations in a rehabilitation program. In order to evaluate inter-rater reliability a prospective evaluation was completed by five independent evaluators ( n = 10). Predictive validity was evaluated retrospectively by comparing the LLAMS predicted LOS to actual LOS ( n = 147). The ability of the amputee team members to administer the LLAMS to patients was very high (ICC [2,1] = 0.98, CI 95% = 0.96 – 0.99, F[9, 36] = 78.71, p < 0.05). In addition, a moderate positive correlation was found between the LLAMS predicted LOS and the actual LOS (Pearson Correlation Coefficient, r = 0.465, p < 0.01), and the LLAMS was able to identify those patients who required short versus long rehabilitation stays. The incorporation of the LLAMS into the physiatrist's initial assessment of patients in the amputee clinic has enhanced the ability to manage better the LOS and the time patients wait to enter the rehabilitation program.

scholarly journals Fracture of the Medial Sesamoid Bone in a professional soccer player

2018 ◽  
Vol 6 (6_suppl3) ◽  
pp. 2325967118S0004
Author(s):  
GM Gastaldi Llorens ◽  
E Gastaldi Orquin
Keyword(s):  
Bone Fracture ◽  
Soccer Player ◽  
Plantar Flexion ◽  
Soft Tissue Injuries ◽  
Rehabilitation Program ◽  
Sesamoid Bone ◽  
Plantar Plate ◽  
Professional Soccer ◽  
Turf Toe ◽  
Professional Soccer Player

The incidence of medial sesamoid bone fracture is rare. Clinically they are often misdiagnosed as soft tissue injuries and often missed. Thus generates an important morbidity for the patient. Objectives: We present a case of turf-toe injury: plantar-plate rupture with medial sesamoid bone fracture in a contact athlete. Methods: A 19-year-old professional soccer player injured his left toe when he planted his foot during a sprint. He had an hyperextension and axial overload traumatism in his toe. On physical examination he had pain, swollen, ecchymosis, instability and loss of plantar-flexion strength. Radiographs showed a transverse medial sesamoid bone fracture with retraction > 3 mm. Magnetic resonance imaging confirmed a subluxation of the proximal phalange and a plantar plate disruption. Because of the completely deficient flexion, the sesamoid retraction, and the articular subluxation, surgery was recommended to restore the MTPJ anatomy. Reduction of the fracture and Repair of the plantar plate was performed using non-absorbable 2-0 Fiber wire sutures through a medial approach. Postoperatively, the patient was placed in a cast, for a total of 2 weeks. After that he began a rehabilitation program. Results: The patient had a complete recovery. He returned to participation in his team at 3 months. At final follow-up, his dorsiflexion ROM was 60 in the involved toe. Conclusion: Turf-toe and disorders of the sesamoid complex is an important injury, often misdiagnosed and usually undertreated. They had an incidence of 25% to 50% of residual pain and limited dorsiflexion in those cases. Despite the incidence of surgical treatment of 2%, we have found hopeful results with the open reduction and internal fixation of the fracture. Accurate and timely diagnosis and treatment can allow for full return to activity for these athletes.

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