Patients perspective on treatment and early rehabilitation after an ankle fracture: A longitudinal qualitative study

The Metal in My Body: Patients' Perception and Attitude Toward Orthopedic Implants

INTRODUCTION

Metal implants are broadly used in orthopedics and traumatology to stabilize bone fragments. This study aimed to explore patients' awareness, body image, and overall experience of living with a metal implant after a fracture.

METHODS

A mixed methods convergent design (QUAN+QUAL) was adopted. A self-reported 30-item questionnaire was used to investigate patients' perception and apprehension of the implantation of orthopedic materials. To enlighten the quantitative findings, semi-structured interviews followed till data saturation. Quantitative and qualitative data were compared during the analysis phase.

RESULTS

Results showed that women's and elders' acceptance of the implants was greater than that of men and younger patients even in acute cases. The sense of superiority provided by the implant was mainly reported by the elderly (adjusted odds ratio (ORadj) for increasing age: 1.06; 95% CI: 1.02-1.1; p<0.01), and the sense of inferiority was mainly reported by young men (ORadj: 6.19; 95% CI: 2.36-16.22; p<0.01). Similarly, women and elderly mostly tended to answer that the injured limb felt stronger after the implant placement, while young men tended to answer a sense of weakness with the implant (ORadj for increasing age: 1.06; 95% CI: 1.03-1.09; ORadj for male gender: 4.67; 95% CI: 1.87-11.7; p<0.01 for both regressions). Most participants (56.6%) and mainly young participants, regardless of gender, expressed the desire to get the metal implants removed (ORadj for increasing age: 0.91; 95% CI: 0.89-0.95; p<0.01). Misinformation and misconception were also found in a high percentage of the questioned patients (48.1%). Thematic analysis of the interviews revealed that none of the participants directly attributed any change in their life, self, or body image to the implants. An altered body image was not reported. The most reported experience was the restriction of movement due to the accident or the subsequent physical weakness.

CONCLUSION

Despite the acceptance of the implant being great, the level of patient knowledge was fairly low. The present study highlights the importance of providing patients with information throughout their management to avoid misunderstandings. Age and gender did influence patients' perception of the implants. Personalized assessment is further needed to address body image issues after an implant placement procedure.

Assessment and management of fractures

Fractures can have significant impact on function and quality of life, and an cause significant disruption to psychological and social wellbeing. A systematic approach is required for the assessment and management of fractures to ensure effective and timely recovery. Nurses play a key role in the care continuum to support the acute and rehabilitation phases of recovery. The use of Patient Reported Outcome Measures ensure a patient-centred approach to management, gauge progress and identify actions needed to optimise recovery. This article outlines the assessment and management of fractures, common concerns and potential complications.

A Unique Physical Therapy Approach in a Complex Case of Pott's Fracture: A Case Report

The ankle joint is a complex joint that bears the human body's weight throughout daily activities. Unimalleolar, bimalleolar, and trimalleolar fractures are the three subgroups that make up the category of ankle fractures. Determining the risk-benefit tradeoffs between non-operative and surgical therapy still requires a thorough initial examination of the fracture pattern, soft tissue condition, and patient characteristics. Ankle fractures that are stable and well-aligned respond well to conservative therapy. Open reduction and internal fixation is the current gold standard of treatment for displaced and unstable fracture patterns, with historical data revealing good to outstanding outcomes for the majority of these patients. We present a case of a 19-year-old female sustaining a Pott's fracture following a road traffic accident. The overall treatment technique used included the overload principle, task-specific training, and an impairment-based strategy. The patient's impairments with regard to the range of motion, strength, edema, discomfort, wound healing, and functional limitations were handled by the therapist using exercises, manual therapy, and compressive cryotherapy. A clinically significant rehabilitation protocol for treating Pott's fracture is established in this case report.

Understanding patient experience of distal tibia or ankle fracture: a qualitative systematic review

To systematically review qualitative studies of patients with distal tibia or ankle fracture, and explore their experience of injury and recovery. We undertook a systematic review of qualitative studies. Five databases were searched from inception to 1 February 2022. All titles and abstracts were screened, and a subset were independently assessed. Methodological quality was appraised using the Critical Appraisal Skills Programme (CASP) checklist. The GRADE-CERQual checklist was used to assign confidence ratings. Thematic synthesis was used to analyze data with the identification of codes which were drawn together to form subthemes and then themes. From 2,682 records, 15 studies were reviewed in full and four included in the review. A total of 72 patients were included across the four studies (47 female; mean age 50 years (17 to 80)). Methodological quality was high for all studies, and the GRADE-CERQual checklist provided confidence that the findings were an adequate representation of patient experience of distal tibia or ankle fracture. A central concept of 'being the same but different' conveyed the substantial disruption to patients' self-identity caused by their injury. Patient experience of 'being the same but different' was expressed through three interrelated themes, with seven subthemes: i) being proactive where persistence, doing things differently and keeping busy prevailed; ii) living with change including symptoms, and living differently due to challenges at work and leisure; and iii) striving for normality, adapting while lacking in confidence, and feeling fearful and concerned about the future. Ankle injuries were disruptive, draining, and impacted on patients' wellbeing. Substantial short- and longer-term challenges were experienced during recovery. Rehabilitation and psychosocial treatment strategies may help to ameliorate these challenges. Patients may benefit from clinicians being cognisant of patient experience when assessing, treating, and discussing expectations and outcomes with patients.

'It Makes Me Feel Old': Understanding the Experience of Recovery From Ankle Fracture at 6 Months in People Aged 50 Years and Over

Ankle fracture is a common injury, and depending on injury severity, treatment may be a support boot, cast or surgery. Older people, particularly those with severe injuries who are asked to restrict weight bearing, struggle with early recovery. To elicit older peoples' experience of recovery 6 months after injury, we drew on a phenomenological approach using interviews. Findings revealed that getting on with life was a way of accepting what it feels like to 'be vulnerable', needing to 'be safe' while determinedly working hard to 'be myself'. Being vulnerable identified endurance of inactivity, loneliness and dependency in the non-weight bearing period of recovery, followed by a struggle to weight bear while lacking confidence and being fearful of falling and causing further damage. Being safe conveyed fragility where sensations, pain and stiffness acted as bodily reminders of injury. Lack of function and awareness of danger led to carefulness where planning or curtailing of activities ensured their safety. Being myself showed a determination to push away from a disrupted self-identify of being older or disabled while being challenged by the continuous process of learning to be more mobile. A lack of readiness for old age created a drive to age well. Despite loss of ability, participants hoped to regain their pre-injury way of living. This study challenges practice that disregards the hard work required to recover from ankle fracture. As comorbidity increases with age, failure to consider this aspect may contribute to frailty in this group of older people.