Weight-bearing Allowed Following Internal Fixation of Ankle Fractures, a Systematic Literature Review and Meta-Analysis.

BACKGROUND: Postoperative management regimes vary following open reduction and internal fixation of unstable ankle fractures. Traditional postoperative nonweightbearing cast immobilization may prevent loss of fixation and protect the soft tissue envelope but may also be associated with poorer functional outcomes. This systematic review and meta-analysis aimed to compare the complication rate and functional outcomes of early weightbearing (EWB) vs late weightbearing (LWB) following open reduction and internal fixation of ankle fractures. METHODS: We performed a systematic review with a meta-analysis of controlled trials and comparative cohort studies using 3 databases. We included all studies that investigated the effect of weightbearing following internal fixation of ankle fractures in adult patients by any means. Studies that investigated mobilization but not weightbearing, non-English-language publications, and tibial Plafond fractures were excluded from this systematic review. We assessed the risk of bias using ROB 2 tools for randomized controlled trials and ROBINS-1 for cohort studies. Data extraction was performed using Covidence online software and meta-analysis by using RevMan 5.3. RESULTS: This systematic review included 10 randomized controlled trials and 4 comparative cohort studies. Most of the included studies were rated as having some concern with regard to the risk of bias. There was no significant difference in the complication rate between the protected EWB and LWB groups (the risk ratio [RR] for infection was 1.30, 95% CI 0.74, 2.30; I² = 0%; P = .36), but better functional outcome scores were detected in the EWB group only at 6 weeks postoperatively (MD =10.08, 95% CI 5.13, 15.02; I² = 0%; P ≤ .0001), with no significant difference seen at 6 or 12 months postoperatively. CONCLUSION: Based on the studies reviewed, it appears that early protected weightbearing following open reduction and internal fixation of ankle fractures does not affect surgical incision or fracture healing and is associated with better early functional outcomes at 6 weeks, but not 6 or 12 months, postoperatively.

Placement of a customised load-bearing titanium plate for prevention of iatrogenic mandibular fracture in surgical removal of odontogenic keratocyst recurrence.

A 72-year-old woman with a history of removal of a right hemimandibular keratocyst 10 years ago was referred to our attention for a large swelling of the right cheek. The orthopantomography and the CT scan showed a huge osteolytic area of the right mandibular ramus and angle. The patient's refusal to resection and reconstruction with a free flap pushed us towards a conservative treatment. The high probability of a iatrogenic mandibular fracture during and after surgery required the design of a customised titanium plate to be preliminary placed through cervical incision along the posterior border of the mandible. The patient successfully underwent the surgical positioning of the customised plate and subsequent removal of the keratocyst. She was discharged fit and well 5 days after surgery. She did not experience any infections, pathological fractures or relapse in the 6-month follow-up.

Total hip replacement in patient with residual poliomyelitis with neglected femoral neck fracture.

A 71-year-old man with residual poliomyelitis was referred to the orthopaedic surgeons with a neglected left femoral neck fracture of the paralytic limb. He had presented at another hospital with left groin pain and inability to weight bear 4 weeks earlier after a fall from standing height, but had delayed treatment due to his insistence on waiting until he returned to his home country.Successful treatment of residual poliomyelitis fractures requires early union as well as early mobilisation and rehabilitation. This patient presented to the orthopaedic surgeons with a challenging case due to the delay in treatment and the fact that the fracture was basicervical which results in an unstable fracture. Surgical expertise was required to decide on the optimum surgical option and a total hip arthroplasty was performed. The patient made a good recovery following physiotherapy as evidenced clinically and radiologically.

Look Before You Leap: Interventions Supervised via Telehealth Involving Activities in Weight-Bearing or Standing Positions for People After Stroke-A Scoping Review.

OBJECTIVE: The COVID-19 pandemic has seen a rapid shift to telehealth-delivered physical therapy services. Common impairments after stroke create unique challenges when providing rehabilitation via telehealth, particularly when it involves activities undertaken in weight-bearing or standing positions, including walking training. Our scoping review maps the evidence regarding safety, efficacy, and feasibility of remotely supervised telehealth interventions involving activities undertaken in weight-bearing or standing positions for people after stroke. METHODS: Searches of relevant databases for primary research studies were conducted using keywords relating to exercise and telehealth. Studies of stroke survivors undertaking interventions involving activities in weight-bearing or standing positions, supervised in real-time via telehealth were included. Two reviewers independently appraised all studies. Data were charted by one reviewer, checked by another, and results synthesized narratively. RESULTS: Seven studies (2 randomized trials, 1 mixed-methods, and 4 pre-post studies) were included, involving 179 participants. Some studies included stroke survivors with cognitive impairment, and 2 (29%) studies included only participants who walked independently. Adherence (reported in 3 studies) and satisfaction (reported in 4 studies) were good, and no serious adverse events (data from 4 studies) related to interventions were reported. Strategies to overcome technological barriers were used to optimize intervention safety and feasibility, along with physiological monitoring, caregiver assistance, and in-person exercise prescription. However, there is limited high-quality evidence of efficacy. CONCLUSIONS: We identified strategies used in research to date that can support current practice. However, urgent research is needed to ensure that stroke survivors are receiving evidence-based, effective services. IMPACT: The COVID-19 pandemic has necessitated a rapid shift to telerehabilitation services for people with stroke, but there is little evidence to guide best practice. Our review provides practical guidance and strategies to overcome barriers and optimize safety and adherence for telehealth interventions involving activities in weight-bearing or standing positions.

Lower extremity joint loading during Bounce rope skip in comparison to run and walk.

BACKGROUND: Bounce rope-skip holds immense scope as an aerobic exercise in space and time constrained urban setting with additional constraints placed by pandemic situations such as Covid 19, wherein adherence to commonly performed weight-bearing, aerobic activities like walking and running is a challenge. Limited knowledge informing biomechanical demands and misconceptions about knee joint loading, confines safe application of bounce rope-skip in health promotion. Thus, present study aimed to explore kinematics and lower-extremity joint loading during rope-skipping compared to walking and running. METHODS: Following ethical approval, 3D motion analysis of bounce rope-skip, walk and run was captured from 22 healthy female participants aged 18-25yr using 12-camera Vicon system and 2AMTI force plates. Three trials for bounce rope-skip were recorded with five skip-jumps on force-plates at a cadence of 105 skips/min. Mid-skip, mid-gait and mid-run data were averaged to compute kinetic and kinematic variables for hip, knee and ankle during loading/initial contact, take-off/push-off and flight/mid-swing phases of rope-skip, walk and run. RESULT: Average time of one rope-skip cycle was 1.2sec; mean foot contact time was 0.55sec and flight time was 0.65sec. In one bounce rope-skip cycle, hip motion ranged between 13.4o-35.3oflexion; knee between 13.6 o-67.9° flexion and ankle between 34.5odorsiflexion to-13.40plantarflexion. Vertical ground reaction force (vGRF) during rope-skip (landing-phase) was lower compared to run; however, it was higher than walk (p < 0.001). In coronal plane, peak hip and knee adductor moment during rope-skip were lower compared to run and higher than walk (p < 0.001). CONCLUSION: Bounce rope-skip generated low lower extremity joint loading compared to run; supporting its prescription as a hip and knee joint-protective aerobic weight-bearing exercise for health promotion in young adults.