Effects Of Postoperative Immobilization Research Articles

The effect of postoperative immobilization in a plaster of Paris back-slab on the surgical wound-healing following the open reduction and plate and screw fixation of the closed calcaneal fractures: a randomised controlled study

Background: Intraarticular calcaneal fractures often need open reduction and internal fixation with plate osteosynthesis. Wound complication is one of the common problems encountered following this. It affects the outcome adversely. Our study was done to assess if a postoperative back-slab can offer any significant difference in the incidence of wound complications. Methods: Out of 42 patients with unilateral intraarticular calcaneal fractures, 20 were provided postoperative slab and continued for six weeks. The remaining 22 patients were not provided any plaster. All patients were followed-up for two years. Results: The incidence of wound dehiscence was 2 in the plaster group as well as 8 in the non-plaster group and this was statistically significant (p=0.02). Also, significantly lower heel widening was reported in the plaster group (p=0.03). Although there was no significant difference in the patient-reported outcome (Maryland Foot Score) and the incidence of pain between the two groups, the occurrence of neurological deficit following surgery and the postoperative range of movements were comparable in these two groups. Conclusions: Thus, it may be concluded that postoperative plaster application for the initial six weeks could be a low-cost yet effective way to reduce wound complications following plate osteosynthesis in intraarticular calcaneal fractures.

A Comparison of Hip Spica Casting to Short Leg Casts and Bar after Hip Reconstruction in Cerebral Palsy.

BackgroundImmobilization after hip reconstruction in children with cerebral palsy varies according to surgeon preference. The effect of postoperative immobilization on postoperative pain is unknown. Success in achieving hip stability and complications may also differ depending on the immobilization technique utilized.Questions/purposesUsing retrospective data, we aimed to evaluate: (a) what effect does postoperative immobilization with hip spica casting versus short leg casts and bar (SLCaB); have on pain and pain management in children with quadriplegic cerebral palsy undergoing femoral and/or pelvic osteotomy? and (b) Do complications and radiographic outcomes differ between those treated postoperatively with hip spica casting and those in short leg casts?Materials and MethodsChildren with quadriplegic cerebral palsy (GMFCS IV-V, mean age 7.8 years [range: 3-15 years]) undergoing femoral or pelvic osteotomy between 2012 and 2014 in the treatment of spastic hip subluxation were reviewed. Modes of immobilization were compared, between spica casting (n=15) and SLCaB (n=12). Preoperative, perioperative, and postoperative pain was quantified between groups. In-hospital epidural dosage, morphine equivalent dosages (MED), adjunctive medications, early maintenance of radiographic hip stability, and all complications were noted and analyzed.ResultsChildren were more likely to have spica cast immobilization if they were younger. Postoperative pain scores were similar between groups, with comparable patterns of epidural and MED administered during hospitalization. Spica casts were often flared up during hospitalization, but skin ulcers were uncommon and comparable between the two groups. Within 12 months of surgery, more ipsilateral femur fractures were observed distant to implants in the hip spica group, although the incidence of fractures did not meet statistical thresholds.ConclusionSpica casting and SLCaB after neuromuscular hip reconstruction did not show a difference in hip stability, narcotic pain medication usage or complication profile.

Paper #11 - The effect of postoperative immobilization on clinical outcome and cuff integrity following arthroscopic rotator cuff repair: a prospective, randomized study of ultrasling vs. abduction pillow

Paper #11 - The effect of postoperative immobilization on clinical outcome and cuff integrity following arthroscopic rotator cuff repair: a prospective, randomized study of ultrasling vs. abduction pillow

The Effect of Postoperative Immobilization on the Healing of Radiofrequency Heat Probe Modified Tissue: Assessment of Tissue Length, Stiffness, and Morphology

The effect of postoperative immobilization on the length, stiffness, and structure of connective tissue after radiofrequency probe shrinkage was examined in a rabbit patellar tendon model. Tendon lengths were measured before, immediately following, and 2, 4, and 8 weeks following heat application, with the contralateral tendon as a control. The animals were randomly assigned to three groups. In Group I, the controls, the animals were allowed free caged activity for 8 weeks. In Groups II and III, the experimental limb was immobilized at 15 degrees of knee flexion for 2 and 4 weeks, respectively, after which the animals were allowed 6 and 4 weeks of free caged activity. Changes in tendon length, stiffness, and cross-sectional area were compared using repeated measures ANOVA and differences between groups examined using Tukey's post-hoc analysis. Patellar tendon lengths were increased in all 3 groups at 8 weeks (P< .001). Tissue elongation was less extensive in group III compared to group I at 8 weeks (P< .001), while tissue cross-sectional area was decreased in both groups II and III compared to group I at 8 weeks (P< .001). All groups demonstrated decreases in tensile strength when compared to controls (P< .001). These findings suggest that postoperative immobilization is important following thermal shrinkage of connective tissue, as early activity can lead to stretching of the heat-modified tissue.

Does Immobilization after Radiofrequency-Induced Shrinkage Influence the Biomechanical Properties of Collagenous Tissue?

Background Despite widespread use of radiofrequency-induced shrinkage of collagenous tissue, there have been no animal studies on the effects of postoperative immobilization on the biomechanical behavior of shrunken tissue. Purpose To examine the role of postoperative immobilization after radiofrequency-induced shrinkage, with special emphasis on the biomechanical properties of shrunken collagenous tissue. Study Design Controlled laboratory study. Methods One patellar tendon of 66 New Zealand White rabbits was shrunk. Six rabbits were sacrificed immediately after surgery. Twenty rabbits were not immobilized, twenty were immobilized for 3 weeks, and twenty were immobilized for 6 weeks. The biomechanical parameters failure strength, stiffness, and relaxation were tested. Results Nine weeks after surgery, biomechanical parameters were still low compared to control tendons. Shrunken tendons did not reach levels of normal tissue at any time after surgery, regardless of whether the animals had been immobilized. According to time-related development, all biomechanical parameters had the lowest levels 3 weeks after surgery. Immobilized tendons demonstrated a better and faster recovery than nonimmobilized tendons compared to the immediate postoperative level. Conclusion Postoperative immobilization supports recovery of biomechanical properties after shrinkage. Despite immobilization, biomechanical properties of shrunken tissue did not completely reach levels of normal tissue. Clinical Relevance Careful rehabilitation is imperative after radiofrequency-induced shrinkage. This animal model supports an immobilization period of at least 6 weeks after surgery.

Effects of postoperative immobilization on the reconstructed anterior cruciate ligament. An experimental study in rabbits.

To investigate the effects of postoperative immobilization and limited motion on reconstructed anterior cruciate ligaments, 28 rabbits received an anterior cruciate ligament reconstruction using autogenous Achilles tendon and were then divided into three groups: fully immobilized, 4 weeks immobilized, and limited motion. Two rabbits from each group were evaluated macroscopically, histologically and microangiographically at 4-week intervals until 12 weeks postoperatively. An additional six rabbits in the 4 weeks immobilized and limited motion groups were studied biomechanically at 12 weeks postoperatively. Macroscopically, both immobilized groups showed more proliferation of the infrapatellar fat pad, which was adherent to the reconstructed anterior cruciate ligament. Histology revealed more rapid regeneration of reconstructed anterior cruciate ligaments in the limited motion group, with no findings of necrosis in the mid-substance. Microangiography indicated faster normalization of vascularity in the limited motion group. The biomechanical study showed no significant difference in laxity between the 4 weeks immobilized and limited motion groups. The graft stiffness and maximum load to failure were greater for the limited motion group, although the increase was not statistically significant. The histologic and microangiographic results from the limited number of animals in this study support limited postoperative motion in the anterior cruciate ligament reconstructed knee. However, there were no differences in terms of the biomechanical parameters at 12 weeks postoperatively between the immobilized and limited motion treatment modes.