Early Postoperative Physiotherapy Research Articles

Fractures of the mandibular coronoid process: A two centres study

The aim of this study was to assess the characteristics of patients with coronoid fractures treated in two European centres over 10 years and to briefly review the literature.This study is based on 2 systematic computer-assisted databases that have continuously recorded patients hospitalized with maxillofacial fractures and surgically treated in two European centres between 2001 and 2010.During the 10 years, 1818 patients and 523 patients with maxillofacial fractures were admitted to the two centres respectively: 21 patients (16 males, 5 females) were admitted with 21 coronoid fractures and 28 associated maxillofacial fractures.A mean age of 42.1 years was observed. The fractures were mainly the result of motor vehicle accidents, followed by assaults and falls. The most frequently observed associated maxillofacial fracture was a zygomatic fracture (13 fractures). In both centres, mandibular coronoid fractures are treated unless a severe dislocation of the fractured coronoid is observed or a functional mandibular impairment is encountered.Conservative treatment can be used, together with the open reduction and internal fixation of associated fractures. The crucial point is to prevent ankylosis, which may be prevented by correct and early postoperative physiotherapy and mandibular function.

Floating Shoulder: Ipsilateral Clavicle, Scapular Body And Glenoid Fracture. A Case Report

We present a case of shoulder instability following a traffic accident. Allman Type I midshaft clavicle, Ideberg Type II glenoid and DeCloux Type I scapular body fractures were diagnosed following radiologic examination. There were no signs of ligamentous injury. Mechanical instability was noted at the shoulder due to breakage of the supportive bony skeleton. The patient was treated surgically with plate and screw fixation. Surgical fixation allowed early postoperative physiotherapy and rehabilitation. This rare injury and its treatment options are discussed in the light of current literature. floating shoulder, scapula, clavicle, glenoid, mechanical instability.

Management of Adult Unilateral TMJ Ankylosis with Temporalis Muscle and Fascia Flap: Review of 51 Cases

ABSTRACTPurposeThis study is aimed to determine the efficacy of temporalis muscle and fascia flap in the treatment of unilateral temporomandibular joint (TMJ) ankylosis in adults. Treatment of TMJ ankylosis has been a topic of debate and the treatment options are multidimensional. Achieving good postoperative mouth opening and functional and cosmetic outcomes of surgery, depends on the method of reconstruction. The need of study is to give the best possible solutions with minimal morbidity to the underlying deformity.Materials and methodsA retrospective study was done on 51 patients to evaluate the postoperative results for unilateral TMJ ankylosis. Parameters such as etiology, postoperative mouth opening on 1st, 2nd, 6th week and 6 months and intraoperative and postoperative complications were recorded. The operative protocol for unilateral TMJ ankylosis entailed: (1) Resection of the ankylotic mass, (2) intraoral ipsilateral coronoidectomy, (3) contralateral coronoidectomy when necessary, (4) interpositional tissue transfer to the TMJ with temporalis muscle and fascia flap, (5) maxillomandibular fixation (MMF) and (6) early mobilization and aggressive physiotherapy.ResultsThe results were encouraging and functional results of interpositional arthroplasty were satisfying with minimal complications. Early postoperative initial aggressive exercise, physiotherapy, and strict follow-up play an important role in preventing postoperative adhesions.ConclusionThe findings of this study support the use of temporalis muscle and fascia flap in adult patients with unilateral TMJ ankylosis.How to cite this articleMishra S, Tripathy R, Sabhlok S, Roy R. Management of Adult Unilateral TMJ Ankylosis with Temporalis Muscle and Fascia Flap: Review of 51 Cases. Int J Head and Neck Surg 2012;3(3):133-136.

Achilles tendon rupture: physiotherapy and endoscopy-assisted surgical treatment of a common sports injury

Although the Achilles tendon (AT) is the strongest tendon in the human body, rupture of this tendon is one of the most common sports injuries in the athletic population. Despite numerous nonoperative and operative methods that have been described, there is no universal agreement about the optimal management strategy of acute total AT ruptures. The management of AT ruptures should aim to minimize the morbidity of the injury, optimize rapid return to full function, and prevent complications. Since endoscopy-assisted percutaneous AT repair allows direct visualization of the synovia and protects the paratenon that is important in biological healing of the AT, this technique becomes a reasonable treatment option in AT ruptures. Furthermore, Achilles tendoscopy technique may decrease the complications about the sural nerve. Also, early functional postoperative physiotherapy following surgery may improve the surgical outcomes.

A Retrospective Study of Temporalis Muscle and Fascia Flap in Treatment of TMJ Ankylosis

This study sought to determine the efficacy of interpositional arthroplasty with temporalis muscle and fascia flap in the treatment of unilateral temporomandibular joint (TMJ) ankylosis in adults. This retrospective study of nine cases evaluated the postoperative results of interpositional arthroplasty on temporalis muscle and fascia flap in adults. The operative protocol for unilateral TMJ ankylosis entailed (1) resection of ankylotic mass, (2) intraoral ipsilateral coronoidectomy, (3) contralateral coronoidectomy when necessary, (4) interpositional tissue transfer to the TMJ with temporalis muscle, fascia flap, and (5) early mobilization, aggressive physiotherapy. The study evaluated nine patients with follow-up checks from 13 to 31 months (mean 18.3 months). Patients had a preoperative maximal interincisal opening of 9-19 mm (mean 11.7 mm). During the last follow-up observation after surgery, the patients had a maximal interincisal opening of 35-40 mm (mean 38.3 mm).The results of this protocol were encouraging, the functional results of interpositional arthroplasty on temporalis muscle and fascia flap were also satisfactory. The findings of this study support the use of temporalis muscle and fascia flap in adult patients with unilateral TMJ ankylosis. Early postoperative initial exercise, physiotherapy and strict follow-up play an important role in preventing postoperative recurrences.

Capsulite rétractile. Traitement chirurgical – Arthrolyse arthroscopique

The arthroscopic capsular release appears as an indication of interest in the therapeutic arsenal for treating such difficult pathology as adhesive capsulitis. Today, the surgical technique of arthroscopic capsular release is well codified, even if some points are still debated. It has to be followed by specific, early postoperative physiotherapy to recover range of motion. The results of arthroscopic capsular release are reliable in improving patients, in terms of pain and function with a satisfactory recovery of range of motion, but often incomplete. Diabetes, whether insulin-dependent or not, is a pejorative factor influencing the result. The question that remains widely debated is what is the right moment to propose this surgery during the evolution of adhesive capsulitis. There is no formal answer yet. Depending on the patient's motivation to recover as soon as possible a satisfactory range of motion (e.g., professional reasons), the indication may be proposed when there is either no response to medical treatment or worsening symptoms despite a well-conducted treatment within a reasonable period of time. This does not take in account duration of the disease since its occurence. It seems logical to propose a surgical indication more rapidly to patients with risk factors such as diabetes. On the other hand, it is not logical to limit this indication to refractory patients with severe stiffness resistant to medical treatment after several years of evolution. The result would be limited and disappointing. A compromise is necessary.

Pediatric flexor tenosynovitis and impetigo: an unusual association?

We describe the case of a child with impetigo in a typical facial distribution who went on to develop flexor tenosynovitis of the hand. The isolated organisms from cultures taken from the face and peri-operatively from the hand were the same (group A beta haemolytic Streptococcus), leading us to believe that there is an association between the conditions in our patient. Impetigo is a common childhood infection typically affecting the peri-oral region. The commonest pathogens are Streptococcus and Staphylococcus (Bernard, Curr Opin Infect Dis 21(2):122–128, 2008). Flexor tenosynovitis most frequently occurs after a breach in the skin on the volar aspect of the affected finger, permitting entry of organisms. If left untreated, this condition can result in significant destruction of the flexor mechanism and subsequent disability of the hand. Our patient made a good recovery following irrigation of the flexor sheath, intravenous antibiotics, and early post-operative physiotherapy. The association between impetigo and flexor tenosynovitis has not been previously made in the literature, and the clinical correlation is important in order to provide prompt and appropriate specialist treatment.

Stellenwert der physikalischen Therapie und Physiotherapie in der postoperativen Schmerztherapie

In times of limited financial and human resources the application of adjuvant physiotherapy postoperatively in orthopaedic patients requires reevaluation. In the early postoperative course physiotherapy improves the patients' mobility. However, it is not able to reduce the need for pain medication. It is intended to minimize complications and to mobilize and motivate the patients early. In contrast, massages are of minor importance in the immediate postoperative course and are applied only in a few selected cases. Cryotherapy plays a major role especially after shoulder and knee surgery. On the other hand, transcutaneous electrical nerve stimulation (TENS) and acupuncture are applied only in selected patients after orthopaedic surgery, e.g., after limb amputation.

Lungenresektionen

The physician involved in internal medicine and general practice is confronted with a series of challenges in patients with pulmonary resection. In the early post-operative phase, optimal analgesia and physiotherapy are the primary factors for achieving the best possible function after loss of pulmonary tissue and for the determination of complications. Post thoracotomy syndrome requires interdisciplinary therapy. In the later course, it is necessary to take into consideration effects on pulmonary circulation, on the musculoskeletal system and on the digestive tract as well as sleep disturbances due to diaphragm dysfunction. Corresponding symptoms should be considered and actively sought, for example using echocardiography for assessment of cor pulmonale or outpatient sleep monitoring for detection of sleep-disordered breathing. Thus, aftercare includes much more than the search for a relapse or formation of metastases in cases of the most common cause of pulmonary resection, bronchial cancer.

Effects of early intensive postoperative physiotherapy on limb function after tibial plateau leveling osteotomy in dogs with deficiency of the cranial cruciate ligament

To determine effects of early intensive postoperative physiotherapy on limb function in dogs after tibial plateau leveling osteotomy (TPLO) for deficiency of the cranial cruciate ligament (CCL). 8 adult dogs with CCL deficiency. After TPLO, dogs underwent a physiotherapy program 3 times/wk (physiotherapy group; n = 4) or a walking program (home-exercise group; 4). All dogs were evaluated before surgery, 1 and 10 days after surgery, and 3 and 6 weeks after surgery. Thigh circumference (TC), stifle joint flexion and extension range of motion (ROM), lameness, and weight-bearing scores were recorded. Before surgery, CCL-deficient limbs had significantly reduced TC and reduced flexion and extension ROMs, compared with values for the contralateral control limb. Six weeks after TPLO, the physiotherapy group had significantly larger TC than the home-exercise group, with the difference no longer evident between the affected and nonaffected limbs. Extension and flexion ROMs were significantly greater in the physiotherapy group, compared with values for the home-exercise group, 3 and 6 weeks after surgery. Six weeks after surgery, the difference in flexion and extension ROMs was no longer evident between the affected and nonaffected limbs in the physiotherapy group. Both groups had improvements for lameness and weight-bearing scores over time, but no difference was found between the 2 groups. After TPLO in CCL-deficient dogs, early physiotherapy intervention should be considered as part of the postoperative management to prevent muscle atrophy, build muscle mass and strength, and increase stifle joint flexion and extension ROMs.

Effects of early intensive postoperative physiotherapy on limb function after tibial plateau leveling osteotomy in dogs with deficiency of the cranial cruciate ligament

Effects of early intensive postoperative physiotherapy on limb function after tibial plateau leveling osteotomy in dogs with deficiency of the cranial cruciate ligament

The management of stress urinary incontinence after radical prostatectomy.

Up to 30% of patients complain about urine leakage after radical prostatectomy, but persistent stress incontinence (beyond 1 year) affects <5% of them. This complication is mainly caused by sphincter dysfunction. Some preventive measures have been described to decrease the risk of incontinence after radical prostatectomy, but with conflicting results. The effectiveness of preoperative and early postoperative physiotherapy is controversial. Moreover, while meticulous apical dissection of the prostate significantly improves postoperative continence, the benefit of other surgical techniques, e.g. preserving the bladder neck and the neurovascular bundles, is under debate. The treatment of persistent stress urinary incontinence is mainly based on surgery, as this type of incontinence usually does not respond to physiotherapy and anticholinergic medication. While injection therapy is safe and well tolerated, its effect on postoperative continence is limited and decreases with time. The best results are achieved by implanting an artificial urinary sphincter, but with significant complication and revision rates.

Fracture-dislocations of the elbow joint--strategy for treatment and results.

Between January 1993 and December 1996, 41 patients with fracture dislocation of the elbow joint were treated in our department. In 28 patients (median age 46 years, range 15-77 years; 16 male, 12 female), a clinical and radiological follow-up was obtained after median 34 months (range 12-59 months). In addition to the humero-ulnar dislocation, isolated fractures were present in 13 patients and combined fractures in 15 (all with involvement of the radial head). Primary neurological deficits were found in 7 and open fractures in 3 patients. In 7 patients, primary definitive surgical therapy was carried out by open reduction and internal fixation. A two-step surgical management (initial closed reduction and immobilization, 5 patients with external fixator, 7 with plaster; secondary open surgical procedure) was performed in 12 and conservative treatment in 9 patients. According to the Leipzig Elbow Score, taking subjective, clinical and radiological criteria into consideration, 4 patients achieved 'excellent' and 5 patients a 'good' result. Ten patients were scored 'moderate' and 9 'poor'. The rate of secondary complications necessitating revision was 36%. Poor results were primarily caused by extensive initial soft-tissue damage, delayed definitive surgical therapy, and ectopic heterotopic ossification. In contrast, fracture localization and degree of arthrosis were not of significant importance for the final outcome. In fracture dislocations, the goal is a primary definitive surgical treatment aiming for early postoperative physiotherapy.

Chronic tenosynovitis of the carpal extensor tendon sheaths in 15 horses.

The history, clinical features, radiological findings, treatment and outcome of 15 horses with chronic tenosynovitis of the carpal extensor tendon sheaths are reported. The condition was seen most commonly in horses used for jumping and penetration of the tendon sheaths by thorns was the most common aetiology. Treatment involved surgical resection of the hyperplastic synovial membrane, and adhesions within the tendon sheath, with primary closure. When combined with early postoperative physiotherapy this was found to be an effective method of treatment. All horses in this series were not lame at follow-up, with 14 horse returning to their former level of athletic performance.