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

Physiotherapy Intervention Focusing on Proprioceptive Retraining for Tibial Pseudoarthrosis Patients Operated With Ilizarov External Fixator: A Case Report

Pseudoarthrosis of the tibia is an uncommon condition that occurs due to non-union of bone and typically requires surgery. It may cause fractures that develop spontaneously or after minor trauma. Physiotherapy is an excellent treatment for this uncommon condition. The tibia of the affected limb becomes malformed and bends backwards. This case report outlines the interdisciplinary programme adopted to successfully manage a 23-year-old female patient with right-sided tibial pseudoarthrosis. Following the implantation of Ilizarov's external fixator to correct the deformity, the patient was referred to the physiotherapy department for post-operative management. After the implementation of a tailor-made physiotherapy protocol focusing on proprioceptive retraining, significant improvements were seen in her joint proprioception, muscular strength and range of motion.

Early outcome measurement of the effectiveness of conventional physical therapy versus continuous passive motion in knee function following retrograde femoral nailing-a prospective randomized controlled trial

PURPOSE

This study evaluated the efficacy of continuous passive motion (CPM) versus conventional physical therapy (CPT) in the early postoperative period following retrograde femoral nailing (RFILN). Based on the principles of operation of CPM, we hypothesized that it would improve knee function and decrease pain after open reduction and internal fixation with a retrograde femoral interlocking nail.

PATIENTS AND METHODS

Eighty-eight patients over the age of 18 years who met the inclusion criteria got randomized into one of two groups. The experimental group had CPM, while the control group had CPT. Postoperative knee functions assessed were the degree of knee stiffness, the total arc of motion, and knee pain. Knee stiffness, defined as the range of motion ≤ 90° assessed one week, two weeks, and six weeks postoperatively, while knee pain was measured using the visual analog scale (VAS) on days one, two, three, four, five, six and seven postoperatively.

RESULTS

The CPM group had a significantly lower incidence of knee stiffness at one week, two weeks, and six weeks postoperatively than the CPT group (all p < 0.0001). The VAS scores of the CPM group on days one, two, three, four, five, six and seven were significantly lower than those of the CPT group (p < 0.006 for day one and p < 0.001 for the remaining days). Similarly, the total arc of motion gained postoperatively was significantly greater in the CPM group than in the CPT (all p < 0.001).

CONCLUSION

The continuous passive motion effectively reduced the number of patients with knee stiffness and knee pain. It increased the total arc of motion in the early postoperative period compared to CPT. Therefore, we recommend CPM for patients undergoing retrograde femoral nailing use in the early postoperative period.

A Toddler's Rehabilitation Following Ilizarov's Tibial Pseudoarthrosis Fixation

One of the rare conditions affecting children is pseudoarthrosis of the tibia. The tibia of the affected leg develops a deformity inflicting it to bend backward. We present one such case, who visited the physiotherapy department for post-operative care after receiving Ilizarov's external fixator, which was used to correct this deformity. On presentation, her hip and knee ranges were significantly reduced, her strength in the affected limb had decreased, and her ankle ranges were almost minimal. Her physiotherapy regimen was meticulously planned with consideration for her age and pleasurable activities, allowing us to easily achieve our desired outcome through this play therapy. We noticed significant improvements in her strength and joint ranges after prescribing her routines to follow at home for a month. We thus conclude that physiotherapy is effective in treating this unusual condition.