Proper Postoperative Rehabilitation Research Articles

Postoperative Rehabilitation with a CAD/CAM-fabricated Occlusal Splint Following Plate Reconstruction after Hemimandibulectomy and Condylectomy: A Case Report.

Mandibular deviation (MD) is a common reconstruction sequela after segmental mandibulectomy. Although proper postoperative rehabilitation is critical for MD management and minimization, the information available is limited. This report describes postoperative rehabilitation with an occlusal splint fabricated using computer-aided design (CAD) and computer-aided manufacturing (CAM) (CAD/CAM-OS) and the results of a threedimensional occlusal analysis using an intraoral scanner after hemimandibulectomy and plate reconstruction. Despite the short follow-up, adherence to postoperative rehabilitation with CAD/CAM-OS for MD correction, even during radiotherapy, was demonstrated by the digital workflow and analysis results.

A STUDY OF MANAGEMENT OF DIAPHYSEAL FRACTURES OF BOTH BONES FOREARM WITH DYNAMIC COMPRESSION PLATING

The forearm serves an important role in the functioning of the upper extremity. Hence aggressive management through good anatomical reduction and internal xation of these fractures has become important. The aim of treatment is to re-establish the normal anatomy and good functional outcome. Early rehabilitation started in the immediate postoperative period to prevent disability to a large extent. The aim of this study is to assess the results of fractures of shaft of both bones of forearm with dynamic compression plate (DCP).30 patients with acute diaphyseal fractures of the radius and ulna were treated with open reduction and internal xation with dynamic compression plate and screws at Osmania general hospital, between November 2016 and April 2019. Cases were taken according to inclusion and exclusion criteria i.e., Adults, both males and females with diaphyseal fracture of forearm bones above the age of 18yrs. Medically unsuitable and patients not willing for surgery were excluded from the study. In our series of 30 cases there were 25 males and 5 females, with average age of 32.6yrs. Good or full range of mobility of elbow and wrist joints with excellent, satisfactory results was present in 28 patients (94%), 1(3%) patient having restriction of elbow motion and pronation and supination and 1(3%) patient with ulnar non-union which recovered with bone grafting. With rigid/anatomical internal xation, dynamic compression plate is a good xation for displaced diaphyseal fractures of the forearm bones. Adherence to AO principles, strict asepsis, proper post operative rehabilitation and patient education are more important to obtain excellent results. Also, external immobilization was not required in cooperative patients.

Rehabilitation and Return to Play of the Athlete after an Upper Extremity Injury

Shoulder and elbow injuries during athletic participation are very common and may require operative intervention if refractory to conservative care. In recovering from these upper extremity injuries, proper postoperative rehabilitation and setting reasonable expectations regarding return to play are very important. This review article focuses on the most common surgically treated shoulder and elbow injuries, including rotator cuff tears, SLAP tears, anterior and posterior shoulder instability, and elbow ulnar collateral ligament tears. Rates of return to play after surgical intervention are encouraging in most professional and recreational athletes but are highly dependent on the severity of injury, as well as the demands and position in sport. Real-world strategies for staged successful rehabilitation are presented and discussed.

Management of fracture both bone of forearm with dynamic compression plating and its outcomes

Introduction: Forearm fractures are one of the most common injuries encountered by an orthopaedic surgeon. Before AO (Association for Osteosynthesis), they were treated with cast immobilization and also other fixation techniques which were described such as intramedullary k-wire, intramedullary nail, external fixator etc. Though still relevant today, however they have been demonstrated to be successful only in selected cases, with high rate of non-union, malunion and with ill effects on the functions of the forearm. The most effective method of producing rigid internal fixation by the use of compression plates was developed by AO School in Switzerland. Objective: The aim of this study is to assess the results of fixation of fractures of shaft of both bone of forearm with dynamic compression plating (DCP) and its advantages and its complications Setting: This study was conducted at the orthopedics department of a teaching hospital in India. Design: This was 2 years prospective, longitudinal, hospital based, observational study, and its outcomes. Participants: The study was done in 30 patients (22 males and 8 females) with fracture both bone of the forearm, who were treated with open reduction and internal fixation with dynamic compression plate and screws at Mahatma Gandhi Memorial Hospital (attached to Kakatiya Medical College, Warangal), between January 2017 to January 2019. Results: Anderson’s criterion was employed to categorize the functional results. Good or full range of mobility of elbow and wrist joints, with excellent and satisfactory results was present in 28 patients (94%), 1 patient (3%) having restriction of elbow motion and pronation and supination and 1 patient (3%) with non-union of ulna, who recovered with bone grafting. Conclusion: Based on our experience and results, we conclude that with anatomic open reduction and rigid internal fixation with dynamic compression plate is a good fixation procedure for displaced diaphyseal fractures of both bone of the forearm. Adherence to strict asepsis, AO principles, proper post-operative rehabilitation and patient education are more important to obtain excellent results.

Results of flexor tendon grafting with early active mobilization

Objective The aim was to evaluate the results of early active motion regimen after hand flexor tendon grafting. Background The application of proper postoperative rehabilitation program is an integral part to achieve good results after hand flexor tendon grafting. The aim of application of early, active mobilization rehabilitation program is to limit adhesion formation which limits active motion. Patients and methods Twenty-three fingers were managed by flexor tendon grafting and assessed from February 2015 till August 2016 at Menoufia University Hospital. In all, 17 fingers had two stages tendon grafting and six fingers had single-stage tendon grafting. Early active mobilization rehabilitation regimen was applied for all patients. Postoperative assessment was done by the American Society for Surgery of the Hand system, Strickland system, Buck-Gramcko method, and LaSalle formula. Results Final assessment was done at 6 months postoperatively and the results were as follows: good (52.17%), fair (39.13%), and poor (8.7%) according to the American Society for Surgery of the Hand system. According to the Strickland system, the results were excellent (13.04%), good (34.78%), fair (39.13%) and poor (13.04%). According to the Buck-Gramcko score, the results were excellent (21.7%), very good (17.4%), good (39.1%) good, fair (8.7%), and poor. (13.1%) According to LaSalle formula, the results were excellent (34.78%), good (52.17%), fair (8.7%), and poor (4.4%). Complications were adhesion formation (8.7%), infection (8.7%), flexor pulley rupture (4.3%), graft rupture (4.3%), and tourniquet palsy (4.3%). Conclusion The results were found to be affected by sex, dominance of affected hand, affected tendon(s), flexor pulley integrity, type of procedure, and by the type of tendon graft.

Functional and radiological outcome of comminuted shaft of humerus fracture treated by dynamic compression plate

<p class="abstract"><strong>Background:</strong> Humeral shaft fractures represents between 3% and 5% of all fractures of which a certain number of patients require surgical intervention. This study aims to determine the efficacy of dynamic compression plate in the treatment of humeral shaft fractures.</p><p class="abstract"><strong>Methods:</strong> A prospective study was carried out over a period of 2 years in Sri Ramachandra Medical College, Chennai including 30 cases of shaft of humerus fractures treated by open reduction and internal fixation using Dynamic Compression plate among which both comminuted and segmental closed shaft of humerus fractures were included. While open fractures and ipsilateral forearm and clavicle fractures were excluded. AO classification was used to classify the fractures and the average follow up period was two years. The American Shoulder and Elbow Surgeons (ASES) shoulder score and Romen al series grading were used.<strong></strong></p><p class="abstract"><strong>Results:</strong> We had 93.3% excellent/good result and 6.7% poor results. In our series we had one non-union, one delayed union and one case of deep infection.</p><p class="abstract"><strong>Conclusions:</strong> Proper preoperative planning, minimal soft tissue dissection, strict asepsis, proper postoperative rehabilitation and patient education were essential to obtain excellent results. Early post-operative mobilization following rigid fixation of the fracture of humerus, with DCP lowered the incidence of stiffness and sudecks dystrophy.</p>

The challenging management of pediatric corneal transplantation: an overview of surgical and clinical experiences.

Pediatric keratoplasty is an immense challenge because of the technical complexity of the procedure and the high risk of rejection in young graft recipients. Our aim is to describe the major indications and appropriate timing of corneal transplantation intervention, including a report of our experience and surgical tips, in conjunction with the current literature. Review of the literature on indications for keratoplasty in pediatric patients classified as: congenital, traumatic and acquired non-traumatic opacities. We additionally explored the challenges corneal surgeons face in performing this type of surgery and review the most pressing transplant-related problems and their management. Outcomes after pediatric keratoplasty, in terms of visual development, restoration and clarity of the graft, are influenced by peri-operative local and systemic conditions and factors, and by intraoperative management of the transplantation procedure itself. Pediatric corneal transplantation is a critical tool for visual restoration and development in young patients with corneal opacities, particularly during the critical period of visual development. Successful management of the significant challenges associated with pediatric keratoplasty requires customized clinical and surgical management of each patient with particular attention paid to proper post-operative rehabilitation.

Http://www.orthopaper.com/archives/?year=2017&vol=3&issue=2&part=J

Background and objectives: The forearm represents a critical anatomic unit of the upper limb, permitting the effector organ of the upper limb, the hand, to perform multi axial daily activities of living. Historically, the closed management of forearm fractures has been met with poor functional outcome in adults, hence perfect fracture reduction and rigid fixation is mandatory and achieved by plating. Conservative treatment has resulted in malunion, nonunion, synostosis and ultimately poor functional outcome [1]. Hence the present study was undertaken to provide satisfactory functional outcome and to know the advantage and complications of the newer plate design, the LC-DCP. Materials and methods: The present study was conducted in Department of Orthopaedics at Sri Siddhartha medical college, hospital and Research Center Tumkur during the period from August 2014 and July 2016. A total of 32 patients attending the hospital during the study period with closed diaphyseal fracture of both bones forearm aged more than 18 years who were medically fit for surgery were included in the study. Results: In this study, Males were predominant with left forearm affection more than right. Most of the fractures were due to road traffic accidents and fall. The average age was 33.5 years with fracture being most common in second and third decade. Most of fractures both bones forearm were located in the middle third and the fracture pattern, transverse/short oblique was commonest. 32(100%) Radius and 32(100%) ulna united within 6 months. The results were based on Anderson et al, scoring system and in our study there were 26 (81%) patients with excellent results, 6 (19%) patients with satisfactory results. Conclusion: Our study shows that LC-DCP plating of both bones forearm produces excellent results when applied properly. To obtain excellent results: proper preoperative planning, minimal soft tissue dissection, adherence to AO principles, strict asepsis, proper postoperative rehabilitation and patient education are mandatory

Complications in Hip Arthroscopy

The primary objective of this study was to determine the minor and major complication rate of hip arthroscopy. The secondary objective was to provide strategies for avoiding complications. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist. Therapeutic hip arthroscopy investigations that reported on adverse events or complications were included. Narrative and other systematic reviews, meta-analyses, conference abstracts or proceedings, and level V evidence studies were excluded. No follow-up minimum was imposed. The results yielded 53 studies (8189 hip arthroscopies in 8071 subjects). Most studies were level IV evidence (74%) with a mean of 2.2±2.1 years follow-up. Femoroacetabular impingement (FAI) and labral pathology were the 2 most common indications for surgery, and osteochondroplasty for FAI and labral treatment were the 2 most common procedures performed. The minor and major complication rates were 7.9% and 0.45%, respectively. Iatrogenic chondrolabral damage and temporary nerve injury were the 2 most common minor complications. Extra-articular fluid extravasation was the most common major complication encountered. Minor complications associated with hip arthroscopy are generally technical in nature and may be related to the learning curve associated with hip arthroscopy. As surgeon experience increases and patient selection improves, a corresponding decline should be observed in minor complications. Strategies to prevent complications include careful preoperative planning, appropriate surgical indications, attention to detail in the operating room, and proper postoperative rehabilitation.

Prevalence of Functional Problems After Oral Cavity Malignancy Treatment at a Tertiary Center: Utilizing PSS HN (Performance Status Scale for Head and Neck) Scale.

Oral cancer is the most common type of cancer occurring in India and it is equally important to assess morbidities after treatment for optimal utilization of resources. Utilizing PSS HN we try to identify the patient population who are severely impaired and need aggressive rehabilitation. The PSSHN questionnaire was administered by the treating physician to 100 consecutive oral cancer patients who completed their index treatment at least 6months prior to accrual. Functional morbidities with score ≤50 were considered as significant. Prevalence of functional deficit of eating in public; deficit of understandability of speech and deficit of normalcy of diet were 28, 13 and 38% respectively. Type of resection either segmental mandibulectomy or major glossectomy, had most significant impact on concerned functional deficits and surgeries involving these defects should be carefully planned to involve free flap reconstruction and proper postoperative rehabilitation.

Current Concepts in Hip Preservation Surgery: Part II--Rehabilitation.

Context:Successful treatment of nonarthritic hip pain in young athletic individuals remains a challenge. A growing fund of clinical knowledge has paralleled technical innovations that have enabled hip preservation surgeons to address a multitude of structural variations of the proximal femur and acetabulum and concomitant intra-articular joint pathology. Often, a combination of open and arthroscopic techniques are necessary to treat more complex pathomorphologies. Peri- and postoperative recovery after such procedures can pose a substantial challenge to the patient, and a dedicated, thoughtful approach may reduce setbacks, limit morbidity, and help optimize functional outcomes.Evidence Acquisition:PubMed and CINAHL databases were searched to identify relevant scientific and review articles through December 2014 using the search terms hip preservation, labrum, surgical dislocation, femoroacetabular impingement, postoperative rehabilitation, peri-acetabular osteotomy, and rotational osteotomy. Reference lists of included articles were reviewed to locate additional references of interest.Study Design:Clinical review.Level of Evidence:Level 4.Results:Hip preservation procedures and appropriate rehabilitation have allowed individuals to return to a physically active lifestyle.Conclusion:Effective postoperative rehabilitation must consider modifications and precautions specific to the particular surgical techniques used. Proper postoperative rehabilitation after hip preservation surgery may help optimize functional recovery and maximize clinical success and patient satisfaction.

Treatment of fractures of the ulnar coronoid process

To discuss the classification, management and outcome of fractures of the ulnar coronoid process. Retrospective analysis was carried out in 31 patients (19 men and 12 women of average age 29.8 years [range, 18-52 years]) with fractures of the ulnar coronoid process. The fractures were classified into four major groups based on the extent of injury to the ulnar coronoid process, the state of the anterior bundle of the ulnar collateral ligaments (UCL) and elbow stability. A fracture of the coronoid process less than halfway up was defined as type I (eleven cases); of the middle of the coronoid process with injury of the UCL as type II (nine cases); of the base of coronoid process with dislocation of the elbow joint, sometimes with injury of the UCL, as type III (six cases); and severe comminuted fracture of the coronoid process with elbow instability as type IV (five cases). We chose treatment according to the type of injury. Follow-up was 18-72 months (average 28.6 months). All patients achieved fracture union without inflammation, neural injuries or elbow instability. One type III and two type IV patients had traumatic osteoarthritis, and two type III and two type IV developed heterotopic ossification. There was a statistically significant difference between the ranges of movement of the two-side joints in type IV. We choose conservative treatment for type I fractures unless the bone fragment affected movement of the elbow joint, in which case we chose operative treatment so that elbow stability was not affected. Type II and type III fractures with elbow instability were reduced by internal fixation and the ligament repaired or reconstructed. In type IV cases, bone reconstruction was necessary to recover elbow stability. Proper post-operative rehabilitation can decrease the occurrence of traumatic osteoarthritis.

Bankart Repair for the Traumatic Anterior Shoulder Instability: At Least 6 Years Follow-up

Purpose : This study compared the long-term clinical results of an open Bankart procedure for anterior shoulder instability with those from an arthroscopic procedure, and evaluated the factors influencing the final outcomes and recurrence. Materials and Methods : One hundred thirty three shoulders with a Bankart repair of a traumatic anterior shoulder instability with a follow-up period of at least 6 years were enrolled in this study. Sixty-seven shoulders had an open repair and sixty-six shoulders, an arthroscopic repair. The mean age at the time of the operation was 27.7 years (range, 17 to 62 years). The mean follow-up period was 100 months (range, 72 to 141 months). Results : At the last follow-up, the pain score during motion improved from 3.86 to 1.36. Forward flexion and external rotation at the side decreased to a mean of 3 degrees, 9 degrees in the opengroup and a mean of 1 degree, 4 degrees in the arthroscopic group. Sixty-two (93%) and 59 shoulders (89%) in the open and arthroscopic group could return to their pre-injury sports activities, respectively. At a mean 12.5 months after surgery, 14 shoulders (10.5%) experienced a redislocation. There were 6 (9%) and 8 (12%) redislocations in the open and arthroscopic groups, respectively. Conclusion : The open group showed relatively better results than the arthroscopic group but there was no significant difference between two groups. Both open and arthroscopic Bankart procedures are effective methods that produce acceptable results when a precise surgical technique and proper postoperative rehabilitation are carried out.

Reverse Shoulder Arthroplasty Indications, Technique, and Results

The surgical treatment of glenohumeral arthritis with rotator cuff deficiency is a difficult challenge. Hemiarthroplasty, the standard treatment at this time, is associated with satisfactory results in a “limited goals” perspective, but often the clinical results are unpredictable. Elevation after hemiarthroplasty approximately 90°. Pain relief can be inconsistent and can deteriorate over time. Constrained prostheses, including ball and socket and reverse ball and socket designs, were introduced in the 1970s to improve upon the results of arthroplasty in this challenging population. Unfortunately, clinical results were inconsistent using these designs, and rates of mechanical loosening and revision were high. The only design that survived has been the prosthesis of Paul Grammont (Dijon, France). His Delta III Prosthesis (DePuy, Warsaw IN) has been in use in its current form since 1992, with good clinical results and relatively low mechanical loosening rates compared with the ball and socket and reversed ball and socket designs of the past. This design is also utilized by the Tornier Aequalis Reversed Prosthesis (Tornier SA, Montbonnot, FR). In Europe, and more recently in the United States, this prosthetic design has proven useful in treating patients with glenohumeral arthritis with extensive cuff deficiency, proximal humeral fracture nonunions and malunions, and failed arthroplasty with a deficient rotator cuff. Predictably good results can be obtained in these difficult circumstances, with good pain relief and elevation often exceeding the horizontal. Active rotation, however, is usually not improved. Complication rates are low in patients with cuff tear arthritis and relatively high in revision arthroplasty cases. As with all revision operations, be they failed cuff repairs or failed prosthetic replacements, there is a higher risk of lingering low grade infections. Results can be optimized and complications minimized with proper patient selection, fastidious surgical technique, and proper postoperative rehabilitation.