Early Range Of Motion Exercises Research Articles

Periarticular Nonunions Around the Knee

Up to 5% of knee fractures do not heal primarily at the expected time (delayed union) or fail to achieve healing (nonunion). The causes and treatment of disturbed bone healing in the distal femur , proximal tibia , and patella and in an increasing number of periprosthetic fractures have been discussed. Infection exclusion and/or eradication, reestablishment of axis, alignment and rotation, rigid fixation with fixed-angle devices and interfragmentary screws, bone grafting , arthrolysis , and early range of motion exercises are all necessary steps for good recovery. Illustrative cases have been presented with authors' preferences in the surgical treatment supported by recent publications.

A Modified Operation for Achilles Tendon Ruptures

Background Treatment of Achilles tendon rupture has long been at the center of debate. Hypothesis A new technique in surgical Achilles tendon repair allows for more stability and earlier rehabilitation. Study Design Case series; Level of evidence, 4. Methods One hundred Achilles tendon rupture patients (70 men, 30 women; age range, 16-54 years; mean age, 32 years) were treated by a newly modified method of repair. Twenty-one of these patients were high-level athletes, and 79 were recreational-level athletes. The average length of follow-up was 2.4 years (range, 1-6.3 years), and none of the ruptures included avulsion fractures. After adjusting the tendon to an adequate length using a Tsuge suture, each fibrous bundle was gathered in a longitudinal direction and fixed with a Bunnell-type suture. The same postoperative physical therapy protocol was applied to all patients: at 1 week, early full weightbearing with a walking cast was initiated, and at 2 weeks, patients began range of motion (ROM) exercises and were instructed to wear a hinged ankle-foot orthosis that permitted full plantar flexion but limited full dorsiflexion. From 6 weeks, patients started practicing double-legged heel raises. Results At an average of 10 weeks, ankle ROM was comparable to that of the nonoperated leg, and double-legged heel raises were achieved at an average of 7.6 weeks. On average, patients were able to do 20 continuous single-legged heel-raising motions (equivalent to manual muscle testing grade 5) at 15.4 weeks, and jogging started at 12.3 weeks. High-level athletes returned to their original sports level at an average of 5 months. Two reruptures (2%) were experienced, but no other complications occurred. Conclusion This surgical technique allows for strong repair stability and subsequent early weightbearing and ROM exercises.

Biomechanical comparison of a unique locking plate versus a standard plate for internal fixation of proximal humerus fractures in a cadaveric model

Newer internal fixation devices with a locking mechanism between the plate and the screw have recently been released. The efficacy of these plates in the proximal humerus has yet to be fully described. There is a need to compare the biomechanical properties of efficacy of plate fixation with or without locking screws for surgery of two-part proximal humerus fractures. Multiple-plane locking plate and cloverleaf plate designs were tested to determine their ability to maintain fixation on the humeral head. Eight matched pairs of cadaveric shoulders with 7-millimeter osteotomy defects at the surgical neck simulating two-part fractures of the proximal humerus were loaded to failure in thirty degrees of glenohumeral abduction. One side was repaired with a proximal humerus locking plate and the other with a cloverleaf plate. The rotator cuff musculature was then loaded via a servo-hydraulic testing machine under displacement control to simulate the deforming forces present in vivo. The average maximum load to failure was greater in proximal humerus locking plates than in cloverleaf plates (876 versus 712; P=0.04). In the cadaveric, two-part proximal humerus fracture model that was created, the locking plate displayed significantly greater holding power of the humeral head. Clinical relevance is unproven but may be manifested in vivo as improved early range of motion exercises and functional outcome.

Postoperative Management: Hand Therapy Program Following Intrafocal Pinning for Juxtaarticular Phalanx Fractures

Intrafocal pinning is a fracture management technique for reduction and stabilization of juxtaarticular phalanx fractures. This technique provides fracture stability with minimal soft tissue disruption from surgery and allows early range of motion (ROM) of the interphalangeal joints. The purpose of this article is to discuss postoperative rehabilitation specific to the management of this fracture and fixation technique that facilitates early ROM, edema control, pin care, custom splinting, and therapeutic exercise.

Pre-formed articulating knee spacer in two-stage revision for the infected total knee arthroplasty.

We performed a prospective study to assess safety and effectiveness of a pre-formed articulating spacer made of gentamicin-impregnated acrylic cement in the management of infected total knee arthroplasty. Twenty-one consecutive patients with unilateral deep infection were treated by two-stage revision in two centres. Two patients were excluded, and 19 patients remained available for assessment. The mean implantation time of the spacer was 12 weeks. The rehabilitation programme between stages consisted in early range of motion exercises and partial weight bearing. Mean follow-up after removal of the spacer and insertion of the final prosthesis was 24 (range, 12-43) months. No patient had recurrence of infection at the latest follow-up. The mean Knee Society functional score during spacer management was rated 75 points and was rated 84 points at the latest follow-up. No device-related complication was observed.

人工膝関節全置換術後の大腿骨か部骨折の治療経験

Femoral condyle fractures following total knee arthroplasty are difficult to manage, because they are periprosthetic and occur in an elderly population.Three female patients with this fracture with an average age of 81.3 years (range ; 76 to 91 years) treated operatively using a plate system were studied.The average period of follow-up was 23 months (range ; 8 to 43 months). The three fractures were 33-A1, 33-C2 and 33-A1 combined with 32-B1 according to the AO classification.All cases achieved complete bone union, but one case of 33-C2 fracture showed malunion of twenty degree anterior convex angulation. One case of 33-A1 fracture operated with LCP (locking compression plate) was allowed early range of motion exercise and full weight bearing.

Getting the Dog Moving After Surgery

Getting the Dog Moving After Surgery

Ｉｎｔｒａｍｅｄｕｌｌａｒｙ Ｓｕｐｕｒａｃｏｎｄｙｌａｒ Ｎａｉｌを用いた人工膝関節置換術後の大腿骨か上骨折に対する治療経験

Supracondylar fracture of the femur following total knee arthroplasty is a serious complication and the management of this complication is controversial. We treated supracondylar fracture of the femur using the Intramedullary Supracondylar Nail (IMSC nail). The advantages of using the IMSC nail are both biomechanical and biological, such as decreased lever arm, and biological advantages of having less periosteal stripping, and preserved alignment. The two largest advantages are the ease of placement of this device and the decreased operative time. The IMSC nail allows early range of motion exercises at the knee without the need for prolonged bed rest. Our case healed while preserving nearly all of the prefracturure range of motion and showed no complications. We concluded that the IMSC nail is an effective method for treating supracondylar fracture of the femur following total knee arthroplalsty.

Risk factors for restricted motion after anterior cruciate reconstruction.

A retrospective review of 373 patients who had undergone anterior cruciate ligament (ACL) reconstruction utilizing the central third of the patellar tendon was undertaken to identify those factors that placed a patient at risk for restricted postoperative motion (flexion < or = 125 degrees or flexion contracture > or = 10 degrees). Stepwise logistic regression analysis determined that the variables most strongly correlated with restricted final range of motion (ROM) were open surgery (P = .0008) and reconstruction performed < or = 7 days after the initial injury (P = .004). Age, associated meniscal repair, or associated collateral ligament injuries did not significantly affect the ROM. A subgroup of 204 patients arthroscopically reconstructed more than 7 days post-injury were significantly less likely to have limited motion when ROM exercises were begun within 2 days of surgery (P = .008). These data support delayed, arthroscopic ACL reconstruction followed by early ROM exercises as useful techniques for avoiding postoperative motion problems.

Reconstruction of the Burned Hand

Several basic principles of burned hand care must be kept in mind at all times. Intervention should be early and aggressive, small splints should be placed within 24 hours, and early tangential excision of the burn should be done within 72 hours. Hemostasis should be absolutely meticulous prior to grafting. Depending upon the availability of donor site skin, full-thickness skin grafts, split-thickness grafts, or meshed split-thickness grafts (expanded or not expanded) are preferred. I have found the functional and cosmetic results to decrease with use in exactly the order stated. The skin graft should be placed with stent or bolster dressings and observed for "take" early. Light active range of motion is usually begun on the tenth postoperative day. Escharotomy or fasciotomy should be performed for any signs of ischemia. In order to control edema, one should be meticulous in the positioning of burned hands, emphasizing elevation, and early range of motion exercises. Pressure garments may be employed when the wound is stable and should continue for 6 to 12 months to control hypertrophic scar formation. Linear scars should not cross any hand joints; Z-plasties are employed over the web spaces. Whenever possible, flaps should be employed to preserve all web spaces and skin grafts used to cover the remainder of the hand. I am aggressive in releasing and reconstructing late deformities such as extension contractures of the wrist, the metacarpal hand, absence of the thumb, finger contractures, and burn syndactyly. These are listed in order of treatment priority. Only in this manner can the patient be returned to "normal life." Patient self-esteem will thus be increased markedly, as will quality of life. It is strongly urged that the surgeon be "captain of the team." The key person in this treatment regimen is the hand therapist, who uses appropriate splints, range of motion exercises, and desensitization programs. I encourage the use of multiple personnel on the "burn team." This may include psychotherapists and, in children, teachers with extraordinary qualities.

The Spectrum of Intramedullary Nailing of the Tibia

Intramedullary nailing of the tibia has been used mainly in selected cases of fresh diaphyseal fractures and nonunions. However, with modern variations of the technique, the indications can be expanded considerably. Interlocking nailing has increased the number of fractures suitable for intramedullary fixation. With this technique or with other additional measures, intramedullary fixation can be used after correction osteotomies and for stabilization of metastases and pathologic fractures. When used on correct indications and in the absence of complications, intramedullary nailing is the method of choice for stabilization of the tibia. The advantages are short stay in hospital, short morbidity, early range of motion exercises, and weight-bearing without immobilization in plaster. A prerequisite, however, is that the surgeon be very familiar with the technique, and its indications and complications.

Percutaneous pin fixation of open severe fractures of the distal third of the forearm

Percutaneous pin fixation of 11 open comminuted severe fractures of the distal third of the forearm resulted in uneventful union and good function and radiological appearance. The lack of serious complications is attributed to the use of the external fixation device, which provides rigid fixation and allows wound redressings and early range of motion exercises without risking loss of alignment.

A modification of the Bristow procedure for recurrent anterior shoulder dislocation and subluxation.

A modification of the Bristow procedure for recurrent anterior shoulder dislocation and subluxation is presented. This report includes 20 shoulders in 20 patients available for adequate followup operated on by senior author from April 1976 to August 1981. The average follow-up period was 42.5 months (3.5 years). The average age at the time of surgery was 24.7 years. No recurrences were noted in the follow-up period. Complications related to screw fixation with Woodruff screws occurred early in the series in three patients (15%), but did not result in instability. Range of motion measurements postoperatively emphasized quantitation of external rotation at 90 degrees of abduction in the operated as compared to the nonoperated shoulder. The average loss of external rotation was 10.3 degrees. Excluding one poor result, this equated to an average loss of only 7.4 degrees. Fourteen of 16 operated dominant arms (87.5%) returned to throwing and overhead motion sports postoperatively. A description of the operative procedure and postoperative rehabilitation course is included. This modification emphasizes accurate and firm repair of the Bankart lesion under excellent operative exposure allowing institution of early range of motion exercises.

Peripheral Nerve Injuries in Children

Recovery after peripheral nerve injuries in children is more complete than in adults and is inversely related to the age of the patient. The prognosis for the return of sensation following laceration of the median, ulnar, or digital nerve depends upon recovery of two point discrimination (in millimeters approximately equal to the child's age) at the time of nerve repair. The better results in children probably reflect the greater adaptability of the immature central nervous system to the nerve injury. Operative exploration of an open wound when there is a potential for nerve injury in an uncooperative child is the only sure way of determining the status of the nerves. Primary repair of cleanly divided nerves in tidy wounds is advocated if it can be done competently. Secondary repair is indicated for avulsion injuries, gunshot wounds, crush injuries, and human or animal bites. Delicate, atraumatic technique and accurate repair of the divided nerve are stressed. The more exacting technique of funicular repair may yield better results. Interfascicular cable grafting is a new and useful alternative to extensive mobilization in closing nerve gaps. Nonoperative treatment of nerve injuries associated with closed fractures is advocated unless there are no signs of nerve regeneration in two to three months. Obstetrical brachial plexus injuries of the upper plexus carry a better prognosis than lower plexus or total plexus injury. Early range of motion exercises to prevent contractures are stressed. Maximal recovery takes place within two years. The acute nerve compression syndrome should be considered an emergency and may require surgical decompression if it is severe and if rapid return of function does not occur following reduction of the fracture.