ABSTRACT
BACKGROUND: About 10% of ankle fractures are located above the syndesmosis, which causes injury to the ligament structure of the syndesmosis. There is no consensus regarding when to allow weight-bearing on the operated limb of patients who suffered ankle fractures requiring intraoperative fixation. OBJECTIVE: The aim of this study is the evaluation of radiographic parameters of syndesmosis reduction and fixation in patients with ankle fracture who underwent immediate protected weight-bearing (use of walking-boot and crutches). PATIENT AND METHODS: Retrospective case series from January 2015 to December 2020. Evaluation of the tibiofibular clear space, tibiofibular overlap, and medial clear space in the preoperative x-ray, immediate postoperative, 3-, 6- and 12-month after syndesmosis fixation and rehabilitation with protected immediate weight-bearing with crutches and walking-boot. RESULTS: Out of 137 ankle fractures 39 were included. There was no significant difference in the tibiofibular clear space between the immediate x-ray and after 12 months (4.5 mm ± 1.1 vs. 4.6 mm ± 1.8; p > 0.999). Tibiofibular overlap hasn't shown significant difference between immediate and 12-month x-ray (6.2 mm ± 2.6 vs. 6.6 mm ± 2.6; p > 0.999). Medial clear space also has shown no worsening from immediate to 12-month x-ray (3.1 mm ± 0.9 vs. 2.8 mm ± 0.9; p > 0.999). There were no fixation failure nor postoperative infection. CONCLUSION: Immediate weight-bearing for patients with ankle fractures with syndesmosis injury and treated with intraoperative fixation with positioning screw proved to be safe with good maintenance of the reduction, no failures of the synthesis material observed and no reports of postoperative infection in the period. LEVEL 3 EVIDENCE: therapeutic retrospective case-series.
Subject(s)
Ankle Fractures , Ankle Injuries , Humans , Ankle Fractures/diagnostic imaging , Ankle Fractures/surgery , Retrospective Studies , Fracture Fixation, Internal , Treatment Outcome , Ankle Joint/diagnostic imaging , Ankle Joint/surgery , Ankle Injuries/diagnostic imaging , Ankle Injuries/surgery , Bone Screws , Weight-BearingABSTRACT
Objective: To evaluate the effects of the self-management program PARQVE in patients with severe knee osteoarthritis (KOA). Methods: Prospective randomized controlled clinical trial with 65 grade IV Kelgren & Lawrence (K&L) KOA patients who were allocated into groups: Control (CG) and Intervention (IG). Both groups received usual care. IG also participated in two days of multi-professional interventions about OA (causes and treatment) and received the program's DVD and book. Standing X-rays were obtained at inclusion and Ahlback's classification was registered. Western Ontario and McMaster Universities Index (WOMAC), Numerical Rating Scale (NRS), Lequesne, weight, and body mass index (BMI) were obtained at inclusion, and after 6, 12 and 24 months. Results: Groups were similar at baseline, despite higher WOMAC stiffness scores and a greater number of Ahlback's grade 4 and 5 in the IG. Only the IG improved WOMAC and total functions (p<0.001) during the study period above 12%, but did not reach the minimal clinically important difference of 20%. Best results were in one year. Non-significant improvements were observed without changes in body composition (P>0.05). Conclusions: Patients with severe KOA have mild to moderate function and quality of life improvement due to self-management program (PARQVE). Level of Evidence I; Therapeutic Studies; Prospective Randomized Controlled Trial.
Objetivo: Avaliar os efeitos do programa de autocuidado PARQVE em pacientes com osteoartrite grave de joelho (OAJ). Métodos: Ensaio clínico prospectivo randomizado controlado com 65 pacientes Kelgren & Lawrence (K&L) grau IV que foram alocados nos grupos: Controle (GC) e Intervenção (GI). Ambos os grupos receberam cuidados habituais. O IG também participou de dois dias de intervenções multiprofissionais sobre OA (causas e tratamento) e seus membros receberam o DVD e o livro do programa. Raios-X em pé foram obtidos na inclusão e a classificação de Ahlback foi registrada. Western Ontario e McMaster Universities Index (WOMAC), Escala de classificação numérica (ECN), Lequesne, peso e índice de massa corporal (IMC) foram obtidos na inclusão, e aos 6, 12 e 24 meses. Resultados: Os grupos eram semelhantes no início do estudo, apesar de maiores escores de rigidez WOMAC e um número maior de pacientes de Ahlback grau 4 e 5 no GI. Apenas o GI melhorou em WOMAC e função total (p <0,001) acima de 12% durante o período de estudo. Os melhores resultados foram após um ano. Melhorias não significativas foram observadas na composição corporal (P> 0,05). Conclusões: Pacientes com OAJ grave apresentam melhora leve a moderada de função e qualidade de vida pelo programa de autogerenciamento (PARQVE). Nível de Evidência I; Estudos Terapêuticos; Estudo Clínico Prospectivo e Randomizado.
ABSTRACT
ABSTRACT Objective: To evaluate the effects of the self-management program PARQVE in patients with severe knee osteoarthritis (KOA). Methods: Prospective randomized controlled clinical trial with 65 grade IV Kelgren & Lawrence (K&L) KOA patients who were allocated into groups: Control (CG) and Intervention (IG). Both groups received usual care. IG also participated in two days of multi-professional interventions about OA (causes and treatment) and received the program's DVD and book. Standing X-rays were obtained at inclusion and Ahlback's classification was registered. Western Ontario and McMaster Universities Index (WOMAC), Numerical Rating Scale (NRS), Lequesne, weight, and body mass index (BMI) were obtained at inclusion, and after 6, 12 and 24 months. Results: Groups were similar at baseline, despite higher WOMAC stiffness scores and a greater number of Ahlback's grade 4 and 5 in the IG. Only the IG improved WOMAC and total functions (p<0.001) during the study period above 12%, but did not reach the minimal clinically important difference of 20%. Best results were in one year. Non-significant improvements were observed without changes in body composition (P>0.05). Conclusions: Patients with severe KOA have mild to moderate function and quality of life improvement due to self-management program (PARQVE). Level of Evidence I; Therapeutic Studies; Prospective Randomized Controlled Trial.
RESUMO Objetivo: Avaliar os efeitos do programa de autocuidado PARQVE em pacientes com osteoartrite grave de joelho (OAJ). Métodos: Ensaio clínico prospectivo randomizado controlado com 65 pacientes Kelgren & Lawrence (K&L) grau IV que foram alocados nos grupos: Controle (GC) e Intervenção (GI). Ambos os grupos receberam cuidados habituais. O IG também participou de dois dias de intervenções multiprofissionais sobre OA (causas e tratamento) e seus membros receberam o DVD e o livro do programa. Raios-X em pé foram obtidos na inclusão e a classificação de Ahlback foi registrada. Western Ontario e McMaster Universities Index (WOMAC), Escala de classificação numérica (ECN), Lequesne, peso e índice de massa corporal (IMC) foram obtidos na inclusão, e aos 6, 12 e 24 meses. Resultados: Os grupos eram semelhantes no início do estudo, apesar de maiores escores de rigidez WOMAC e um número maior de pacientes de Ahlback grau 4 e 5 no GI. Apenas o GI melhorou em WOMAC e função total (p <0,001) acima de 12% durante o período de estudo. Os melhores resultados foram após um ano. Melhorias não significativas foram observadas na composição corporal (P> 0,05). Conclusões: Pacientes com OAJ grave apresentam melhora leve a moderada de função e qualidade de vida pelo programa de autogerenciamento (PARQVE). Nível de Evidência I; Estudos Terapêuticos; Estudo Clínico Prospectivo e Randomizado.
