Fracture Rehabilitation Research Articles

Mid-shaft clavicle fractures-factors influencing the clinical outcome after plate osteosynthesis

<p class="abstract"><strong>Background:</strong> Clavicle fractures constitute 5-10% of all fractures with. These fracture result from accidental fall, sports injuries or road traffic accidents The location and fracture pattern are important as it decides treatment and outcome. Our study is aimed to assess the various factors like: fracture pattern, type of implant used, and plate positioning and assessing their influence on clinical outcome.</p><p class="abstract"><strong>Methods:</strong> It was a prospective case-study. The study was done in department of orthopaedics, Government Villupuram Medical College Hospital Villupuram between December 2017 and December 2019. Those patients in whom there was indication for surgical management, and who were willing for surgery were admitted. Plate osteosynthesis was done using anatomical locking plate, recon plate, tubular plate. Post operative rehabilitation done. Functional and radiological assessment done at regular interval till fracture union.<strong></strong></p><p class="abstract"><strong>Results:</strong> All 32 patients had good union. Mean interval for fracture union was 4 months. 2 cases had implant failure, for which implant exit was done without any complication.</p><p class="abstract"><strong>Conclusions:</strong> Anatomical locking plate prove to be the ideal implant for management of mid shaft clavicle fracture. Failure by mechanical mode can be prevented by using lag screws and avoiding fracture spanning. Biological mode of failure can be prevented by guarded post operative rehabilitation in comminuted fractures.</p>

Evidence-based intervention on postoperative fear, compliance, and self-efficacy in elderly patients with hip fracture.

BACKGROUNDElderly patients tend to have poor self-efficacy and poor confidence in postoperative rehabilitation for hip fractures, and are prone to negative emotions, which affect treatment compliance.AIMTo evaluate the effects of evidence-based intervention on postoperative fear, compliance, and self-efficacy in elderly patients with hip fractures.METHODSA total of 120 patients with hip fracture surgically treated from June 2018 to June 2020 at the orthopedic department of our hospital were selected and divided into intervention and routine groups (n = 60 each) according to different nursing methods. The basic rehabilitation methods of the two groups were consistent, but patients in the intervention group received evidence-based nursing interventions at the same time. Differences between groups in the scores of motion phobia, pain fear, rehabilitation training compliance, self-efficacy, nursing satisfaction, and hip joint function were compared before and after the intervention. RESULTSBefore the intervention, there were no statistically significant differences in motion phobia and pain fear scores between the groups (all P > 0.05). However, motion phobia scores at 1 wk after intervention initiation (P < 0.05), and pain fear scores at 1 wk and 2 wk after intervention initiation (all P < 0.05), were significantly lower in the intervention group than in the routine group. On the first day of intervention, there was no significant difference in rehabilitation treatment compliance between the groups (P > 0.05); however, at 2 wk after intervention initiation, rehabilitation compliance was significantly better in the intervention group than in the routine group (P < 0.05). Before the intervention, there were no statistically significant differences in the scores for the two self-efficacy dimensions (overcoming difficulties and rehabilitation exercise self-efficacy) and the total self-efficacy score between the groups (all P > 0.05). After 2 wk of intervention, the scores for these two dimensions of self-efficacy and the total self-efficacy score were significantly higher in the intervention group than in the routine group (all P < 0.05). At 3 and 6 mo after surgery, hip function as evaluated by the Harris hip score, was significantly better in the intervention group than in the routine group (P < 0.05). Additionally, overall nursing satisfaction was significantly higher in the intervention group than in the routine group (P < 0.05). CONCLUSIONEvidence-based nursing intervention can alleviate fear of postoperative rehabilitation in elderly patients who underwent hip fracture surgery, and improve rehabilitation treatment compliance and patient self-efficacy, which promote hip function recovery.

Current Practice of Italian Association of Revision Surgery Members in the Treatment of Unified Classification System Type B Periprosthetic Femoral Fracture Around Hip Arthroplasty: A Cross-Sectional Survey.

IntroductionPeriprosthetic femoral fracture around hip arthroplasty are growing in the world, nevertheless management and treatment options for fractures “around the stem” are still debated due to lack of high-level studies.Materials and methodA 85-item survey were fill out by 40 Italian Orthopedic Surgeon member of SIOT (Società Italiana di Ortopedia e Traumatologia) and AIR (Associazione Italiana Riprotesizzazione) to assess their current opinion in the management of type B periprosthetic femoral fractures. Responses were summarized using proportions, and further stratified by practice type, case volume, surgeon age, and fellowship training.ResultsVancouver/UCS fracture classification showed a good interobserver agreement (k value = .76). ORIF were the treatment of choice for UCS type B1 fractures (100%), revision stem for B2 (85%) and B3 (100%). Locked plates were preferred to cable plate and cerclage without a plate for B1 fractures (50% vs 40% vs 10%); revision with modular stem was preferred to monoblock stem for B2 fractures (50% vs 35%) and B3 (75% vs 15%). Responders tended to postpone at 1-month weight-bearing in patients with B1 fractures. Regarding postoperative pharmacological treatment there was absolute lack of consensus.DiscussionThe primary finding of our survey confirmed the preference of ORIF for B1 fractures and stem revision for B2 and B3 fractures. However, there is no definitive operative technique for all UCS B fractures. Surgeons tended to favor locked plating over cable plating, although only slightly. This general lack of consensus coincides with the inconclusive evidence that currently exists in the literature, which demonstrates both favorable and unfavorable outcomes for both techniquesConclusionsThe absence of complete homogeneity among participants showed the need for prospective randomized studies to set up stronger guidelines for classification, management, surgical treatment, rehabilitation, and pharmacological support of periprosthetic femoral fractures.

Management for the rehabilitation of atrophic mandible fracture: case using a conservative approach and short implants

The treatment of atrophic jaw fracture is a challenge in maxillofacial surgery, due to both local and systemic factors of the affected patients. This article aims to report a case of bilateral atrophic fracture of the mandible treated with an intraoral approach through a thinner and locked 2.0 mm system mandibular plate and subsequent rehabilitation with an implant- supported prosthesis. This technique provided the patient with excellent masticatory, aesthetic, and functional recovery with less morbidity and faster recuperation.

Hand laterality recognition in distal radius and/or ulna fracture

Hand laterality, an important ability to determine the orientation of a limb is common to get affected after short term immobilization. Distal radius and/or ulna fracture is a commonly encountered fracture resulting from upper-limb trauma. Conservative treatment using closed reduction and plaster cast application to immobilize the joint remains choice of treatment over surgery in the treatment of these fractures. There is a paucity of literature reporting impairment in hand laterality after long term immobilization as commonly performed in patients with distal radius and/or ulna fractures. Understanding effect of immobilization on hand laterality in distal-end radius/ulna fractures warranted present investigation. To evaluate hand laterality based on the accuracy and response time for hand determination after plaster cast removal in distal radius and/or ulna fracture. Prospective cross sectional study. Subjects (n=60, age range=40-59 years, females (n)=28 and males (n)=32) were shown 24 real-hand images with various degrees of angular rotation and instructed to identify the hand as left and/or right. Accuracy (% correctly identified) and Response time (milliseconds to identify left or right hand in the image) of motor imagery during hand laterality task were recorded. Pain intensity before and after the hand laterality task were noted using Visual Analogue Scale. Repeated measures of ANOVA and t tests were used to analyze the accuracy and response times among two groups. The experimental group showed significantly (P < .05) lower accuracy and longer response time as compared to the control group. No significant difference in the accuracy and response time were noted in the immobilization of the dominant and the non-dominant hand within the experimental group (P > .05). Also, there was no change in pain pre- to post-hand laterality task. Findings of this study could aid in enhancing the understanding of post-immobilization effect on hand laterality and open new arenas for assessment and rehabilitation of distal-end radius and/or ulna fractures where immobilization is the principal treatment.

Prolonged Application of Continuous Passive Movement Improves the Postoperative Recovery of Tibial Head Fractures: A Prospective Randomized Controlled Study

Methods 60 patients with THFs were randomly and equally divided into the CPM group and non-CPM group. Both groups immediately received CPM and conventional physical therapies during hospitalization. After discharge, the non-CPM group was treated with conventional physical therapy alone, while the CPM group received conventional physical training in combination with CPM treatment. At 6 weeks and 6 months postoperatively, the primary outcome which was knee ROM and the secondary outcome which was knee functionality and quality of life were evaluated. Results The CPM group had a significantly increased ROM at both follow-up time points. The Knee Society Score, UCLA activity score, and the EuroQoL as well as the pain analysis showed significantly better results of the CPM group than the non-CPM group. Conclusions The prolonged application of CPM therapy is an effective method to improve the postoperative rehabilitation of THFs.

Observation on Effect of Pain Control Nursing on Postoperative Rehabilitation of Knee Joint Fracture

Observation on Effect of Pain Control Nursing on Postoperative Rehabilitation of Knee Joint Fracture

Factors contributing to fall rate and second fall in older adults after rehabilitation of fractures: A prospective cohort study

Factors contributing to fall rate and second fall in older adults after rehabilitation of fractures: A prospective cohort study

Comparative Analysis of Preoperative and Postoperative Muscle Mass around Hip Joint by Computed Tomography in Patients with Hip Fracture.

PurposeThis study was conducted in order to assess changes in hip muscles by comparing results of preoperative and postoperative computed tomography (CT) in older patients who underwent surgery for treatment of hip fracture.Materials and MethodsA total of 50 patients (aged ≥65 years) who underwent surgery for treatment of intertrochanteric fractures (25 patients) and femoral neck fractures (25 patients) between February 2013 and February 2019 and underwent preoperative and postoperative pelvic CT were enrolled in the study. The cross-sectional area, attenuation and estimates of muscle mass of the gluteus medius, gluteus minimus, iliopsoas, and rectus femoris on the uninjured side were measured. Basic patient data (sex, age, height, weight, body mass index [BMI], bone mineral density [BMD], Harris hip score [HHS], and length of follow-up) were collected from medical records.ResultsNo significant differences in sex, age, height, weight, BMI, BMD, HHS, and length of follow-up were observed between the two groups. No significant difference in the cross-sectional areas and attenuations of gluteus medius and gluteus minimus was observed after surgery; however, a statistically significant decrease was observed in those of iliopsoas and rectus femoris after surgery. Lower estimates with statistical significance of muscle mass of the iliopsoas and rectus femoris were observed on postoperative CT.ConclusionMuscle mass of the hip flexor (iliopsoas, rectus femoris) showed significant decreases on postoperative CT compared with preoperative CT. Based on these findings, selective strengthening exercise for hip flexor should be beneficial in rehabilitation of hip fractures.

Early Rehabilitation of Orthopedic Internal Fixation Removal in Daytime Ward

Children's fractures are very common, and many children's fractures need internal fixation. When the children are treated and recovered, it needs to be internally fixed and then taken out. With the development of internal fixation materials, the research of surgical methods and the improvement of surgical skills, postoperative removal of orthopedic surgery patients has gradually been included in daytime surgery. While ensuring the safety of children's surgery, it is necessary to shorten the postoperative limb and joint function recovery time, promote the recovery of limb and joint function, the healing of wounds and bones, and reduce the occurrence of these complications. In order to reduce the occurrence of these complications, carry out early rehabilitation education and development early rehabilitation training is very necessary. This paper puts forward the concept of early rehabilitation based on shared decision model, in which doctors, nurses, children and family members participate in the treatment of children before, during and after operation. The effect of early rehabilitation education in the daytime ward after removal of internal fixation was examined. Moreover, through the analysis of the control trial also confirmed that the clinical effect of early rehabilitation in improving and optimizing the rehabilitation of fracture in children is significant.

Electrospinning nanofibres in the exercise rehabilitation after fracture of anterior cruciate ligament

This study was to analyse the application of electrospinning (EP) nanofibres in the rehabilitation of fracture of anterior cruciate ligament (ACL). The patients in groups A, B, and C were treated with exercise rehabilitation, ozone therapy combined with rehabilitation exercises, and EP nanofibre stents for anterior cruciate ligament reconstruction. It was found that the water contact angle of the dissolved and blended nanofibres decreased as the specific gravity (SG) of PCL increased; and the elongation rate and mechanical properties of nanofibre materials increased as the tensile strength increased. The scores of ligament injury for patients in the control group (78.66 ± 6.24) and the experimental group (89.65 ± 5.89) were much higher than those in the blank group (62.1 ± 6.02), showing statistical differences (P < 0.05). It showed that the nanofibre stent was successfully prepared, which had good mechanical properties and hydrophilicity.

Influence of Psychological Supervision on Athletes' Compliance, Mental Elasticity Characteristics and Acute Stress Disorder in Traumatic Fracture Rehabilitation Training.

Background:We aimed to explore the effect of psychological supervision on rehabilitation training compliance, mental elasticity characteristics, and acute stress disorder.Methods:From March 2018 to March 2020, 128 athletes with traumatic fractures in Zhoukou Sports Club in China were divided into two groups using the random number table method, The intervention group (64 athletes) received psychological supervision during the rehabilitation training, while the control group (64 athletes) without psychological supervision. The rehabilitation training compliance in the two groups was observed, and the mental elasticity characteristics and acute stress disorder changes were compared between the two groups before and post-intervention.Results:The compliance rate during postoperative rehabilitation training in the intervention group is 92.19%, which was significantly higher than 73.44% in the control group (P<0.05). Compared with the scores before intervention, the CD-RISC score and SASRD score of the two groups were significantly lower than the scores post-intervention. The SMFA function and vexation indexes of the intervention group in three months after operation were significantly lower than those of the control group (P<0.05). The QOL scores of the intervention group in social, environmental, psychological, and physiological fields were significantly higher than those of the control group in three months after operation (P<0.05).Conclusion:The implementation of psychological supervision for athletes with traumatic fractures could improve rehabilitation training compliance, increase the level of mental elasticity, and relieve acute stress disorder.

Impact of Artificial Intelligence in the Physiotherapy Rehabilitation of Distal Radial Fracture Patients: A Review

Background: Physiotherapy is the desired therapeutic intervention for the recovery of fractures and discomfort associated with bones. In certain cases the patient may suffer from extreme pain because of sudden jerks or injuries. The goal of this review was to map out the available literature on virtual reality in distal radius fracture rehabilitation across physiotherapy disciplines.&#x0D; Methods: An extensive and systematic search of the following databases was undertaken- Embase, Cochrane Library, PEDro, and CINAHL. The MeSH search items used were articles with “artificial intelligence, “machine learning” “virtual reality” “physiotherapy”. Articles were identified if they described an intervention which is considered within the scope of a physiotherapist and targeted those with DRF.&#x0D; Results: Total 35 were initially procured from which 26 articles were included, out of which 13 were observational, 6 Randomized Control Trials, 2 qualitative, 2 surveys and 3 systematic reviews. Only 9 studies focused explicitly on physiotherapy interventions.&#x0D; Conclusion: The results of there view indicate that there is insufficient evidence to direct physical therapists in the treatment of individual with distal radius fracture using artificial intelligence.

Evaluation on the Effect of Personalized Functional Rehabilitation Nursing in Promoting Lower Limb Fracture Rehabilitation

Evaluation on the Effect of Personalized Functional Rehabilitation Nursing in Promoting Lower Limb Fracture Rehabilitation

A Review on: 3D Printed Orthopaedic Cast for Improved Forearm Fracture Rehabilitation

Abstract: Forearm fracture has many management related problems. In order to regain its function anatomical reduction and immobility is very necessary. Traditional cast is not a satisfactory cast as it is heavy, poorly ventilated and often causes fracture related complications. The paper deals with application of 3D printing technique for suitable cast for forearm rehabilitation. Novel 3D printed cast is light weighted, ventilated, custom fit, strong and waterproof and substantial improvement over conventional orthopaedic cast. With the development in technology, it is expected that the cost of fabrication and its manufacturing time will be greatly reduced in the coming future. Keywords: bone fracture, immobility, rehabilitation, 3D printing, orthopaedic cast

Improving hip fracture rehabilitation against CSP standards using an integrated physiotherapy and occupational therapy team approach

Purpose: The 2017 RCP HipSprint audit showed a wide variation in provision of rehabilitation across the country and the CSP published Hip Fracture Rehabilitation Standards in 2018. Our baseline HipSprint audit identified we were delivering significantly less than the recommended 2h rehabilitation per week.

248 UNINTENDED CONSEQUENCES: DID THE PANDEMIC LEAD TO REDUCED REHABILITATION LENGTH OF STAY POST HIP FRACTURE?

Abstract Background The aim of this study was to compare hip fracture rehabilitation outcomes during the COVID-19 pandemic (2020 data) against comparable control data (2015–2019). Variables examined included patient demographics, time to transfer (acute length of stay), rehabilitation length of stay and discharge destination. Methods An audit was completed using the local anonymised hip fracture data collected during 2020. This data is collected as part of an ongoing quality improvement initiative to improve the hip fracture rehabilitation pathway. A review of previous local annual hip fracture reports was completed to allow comparison of key outcomes. Results For the control period (2015–2019) the mean number of hip fractures admitted per year was 98 compared to 59 during 2020 (periods of closure). During the control period, 78% of admissions were female and mean age was 82 which is similar to 2020 with 83% females mean age of 83. Almost half of patients lived alone (49%) which is similar to the control period (48%). Despite the added complexity to the transfer process (swabbing and isolation) the mean time to transfer from acute was reduced by 1 day. The mean post-acute rehabilitation length of stay significantly reduced in 2020 to 37 days compared to 49 days during the control period. There was a reduction in number of patients who discharged home, 88% in 2020 compared to 93% in control period. This is reflected in the increased number who discharged to nursing home care, 7% in 2020 compared to 4% in control period. Conclusion There may be multiple contributing factors that led to the significant reduction in rehabilitation length of stay including increased rehabilitation staffing ratios during the pandemic due to reduced occupancy, expedited home support services, increased community response teams and patient and family wish to accelerate discharge secondary to concerns of risk of COVID-19 exposure in the hospital setting.

Factors associated with actual skeletal muscle mass increase during hip fracture rehabilitation of persons aged 80 and older

ObjectivesThis study aimed to evaluate actual skeletal muscle mass change and factors associated with its increase in patients aged ≥80 years undergoing hip fracture rehabilitation. MethodsThis case-control study was conducted in the rehabilitation hospital. Participants were 368 patients aged ≥80 years undergoing hip fracture rehabilitation. Patients were divided into two groups based on the change of skeletal muscle mass index (SMI) during hospitalization: two groups with increased SMI and without increased SMI, after evaluation of skeletal muscle mass changes. Analysis between two groups and multivariate logistic regression analysis were performed to evaluate the factors associated with SMI increases. ResultsThe SMI at discharge was significantly increased (5.20 kg/m2) compared to baseline (5.00 kg/m2; p <0.001). The significant differences were observed in SMI on admission, length of hospital stay, duration of exercise therapy and BMI gain between two groups. Multiple logistic regression analysis showed that hospital stay and period of exercise therapy were significantly associated with increased SMI (OR: 1.020, and 1.010 respectively; and 95% CIs: 1.010–1.030, and 1.000–1.030, respectively). Moreover, BMI and SMI on admission, and BMI gain were significantly associated with increased SMI. ConclusionsWe demonstrated that old patients with hip fractures achieved significantly increased skeletal muscle mass during rehabilitation and that BMI and SMI on admission, BMI gain, length of hospital stay, and duration of exercise therapy were factors independently associated with increased SMI. Even older patients should take exercise to acquire skeletal muscle, rather than refraining from exercising due to old age or hip fractures.

Prevalence and prognostic significance of depressive symptoms in a geriatric post-hip fracture assessment

Objectives To investigate the prevalence and prognostic significance of post-hip fracture depressive symptoms. Methods A naturalistic clinical cohort study. Data were collected on admission to hospital, geriatric assessment 4–6 months post-fracture and by telephone interview one-year post fracture. Depressive symptoms were assessed at the geriatric assessment using the 15-item Geriatric Depression Scale (GDS-15). Logistic regression analyses with multivariable models were conducted to examine the association of depressive symptoms with changes in mobility and living arrangements and Cox proportional hazards models for mortality between the geriatric assessment and one-year follow-up. Results Of the 1070 patients, 22% (n = 238) had mild and 6% (n = 67) moderate to severe depressive symptoms. Patients with depressive symptoms had poorer nutritional status at baseline, lower scores on the cognitive and physical performance tests and poorer functional abilities in the geriatric assessment than those without. No association was observed between depressive symptoms and any of the outcomes at one-year follow-up. Poor nutritional status and physical functioning remained significant prognostic indicators. Conclusion Post-hip fracture depressive symptoms are common and deserve attention during post-hip fracture recovery and rehabilitation. Nonetheless, depressive symptoms have no impact on the change in mobility or living arrangements or mortality. These latter outcomes are mainly explained by poor nutritional status and functioning.

Independent factors that attenuate the effectiveness of fracture rehabilitation in improving activities of daily living in female patients aged 80years and above.

Some factors, such as cognitive impairment, can attenuate the effectiveness of rehabilitation. We hypothesized that handgrip strength (HGS) might be one of the independent factors affecting the activities of daily living (ADL) improvements in patients with fractures. This study aimed to evaluate the relationship between HGS and improvement in ADL during rehabilitation, and to assess the factors affecting ADL improvement among older patients ≥ 80years with fractures. This longitudinal study was conducted at a rehabilitation hospital among 427 females aged ≥ 80years, who underwent fracture rehabilitation. Patients were divided into two groups based on their HGS. Analysis of comparison between the two groups and multivariate linear regression analyses were performed with respect to functional independence measure (FIM) gain during rehabilitation. FIM gain was significantly lower in the weak HGS group (31.5 [20.0-41.0]) than in the strong HGS group (35.0 [27.5-47.0], p = 0.011). In multivariate linear regression analyses, HGS was significantly associated with FIM gain (coefficient: 0.683, 95% confidence intervals 0.302-1.064, p < 0.001). In addition, Mini-Mental State Examination, necessity of assistance in ADL before injury, length of hospital stays for rehabilitation, and period of rehabilitation per day were significantly associated with FIM gain. Weak HGS, cognitive impairment, and necessity of assistance in ADL before injury could be independent factors that attenuate the effectiveness of fracture rehabilitation to improve ADL in old female patients. We encourage such patients to undertake more rehabilitation for improving their ADL, and not refrain from rehabilitation due to old age and fracture.