Gait Alterations in Adults after Ankle Fracture: A Systematic Review

Comparing lateral plantar process trabecular structure to other regions of the human calcaneus

Investigating skeletal adaptations to bipedalism informs our understanding of form-function relationships. The calcaneus is an important skeletal element to study because it is a weight-bearing bone with a critical locomotor role. Although other calcaneal regions have been well studied, we lack a clear understanding of the functional role of the lateral plantar process (LPP). The LPP is a bony protuberance on the inferolateral portion of the calcaneus thought to aid the tuberosity in transmission of ground reaction forces during heel-strike. Here, we analyze LPP internal trabecular structure relative to other calcaneal regions to investigate its potential functional affinities. Human calcanei (n = 20) were micro-CT scanned, and weighted spherical harmonic analysis outputs were used to position 251 volumes of interest (VOI) within each bone. Trabecular thickness (Tb.Th), spacing (Tb.Sp), degree of anisotropy (DA), and bone volume fraction (BV/TV) were calculated for each VOI. Similarities in BV/TV and DA (p = 0.2741) between the LPP and inferior tuberosity support suggestions that the LPP is a weight-bearing structure that may transmit forces in a similar direction. The LPP significantly differs from the inferior tuberosity in Tb.Th and Tb.Sp (p < 0.05). Relatively thinner, more closely spaced trabeculae in the LPP may serve to increase internal surface area to compensate for its relatively small size compared to the tuberosity. Significant differences in all parameters between LPP and joint articular surfaces indicate that trabecular morphology is differently adapted for the transmission of forces associated with body mass through joints.

Comprehensive Physiotherapy Protocol in Post-operative Case of Trimalleolar Fracture: A Case Report

A common ankle fracture that can have major consequences and expensive medical bills is the trimalleolar fracture. The trimalleolar fracture is the least frequent type of ankle fracture. The number of afflicted malleoli, the kind of fracture of the lateral and medial malleolus and the congruence of the ankle joint were all examined in detail for the trimalleolar ankle fracture. This type of fracture is brought on by high-energy trauma. In this case report, we describe a 56-year-old female patient who was involved in a road traffic accident. After being taken to the hospital for further examination, her ankle fracture was determined to be a trimalleolar one. She had an internal fixation with canulated cancellous screws and nails for open reduction. For such patients, we designed a physiotherapy course based on early rehabilitation and sensorimotor retraining to help with proprioception training, gait training and lower-limb muscular strength training. The lower limb's strength and range of motion were improved with the treatment. The outcomes used were the numerical pain rating scale (NPRS), functional independence measure (FIM), lower-extremity functional scale (LEFS), range of motion (ROM), gait parameters and manual muscle testing (MMT).

The Effectiveness of Rehabilitation Program After Hybrid Osteosynthesis in Ankle Joint Unstable Injuries

Aim: To develop a rehabilitation protocol for patients with the unstable ankle joint injuries by doing comparative analysis between HSEF functional results and the traditional method. Materials and Methods: The study was performed on 61 patients with the unstable ankle trans- or supra-syndesmotic fractures. Patients were divided into two equal groups where I = main and II = control due to the age, distribution and disorders. 10 patients from the group I were operated using HSEF, the other 51 were selected for the traditional osteosynthesis (plate and positioning screw). For the monitoring of osteosynthesis quality was used The Foot and Ankle Disability Index (FADI) scale. Nonparametric statistical analysis was completed using Statistica 13.0 computer software. Results: After application of HSEF method authors of this paper created original rehabilitation protocol. Limitations in the rehabilitation process (e.g., not weightbearing) on 42}3 day in the control group II caused a significant gap in the results of ankle joint functional recovery. On day56}3, the main group I overreached the control group II by 1.5 (p3<0.001). With each FU 1-3 of the main group I, the total sum of points according to FADI (subscale of sports activity) steadily increased by 5, and with FU 3 on the 56}3 day, reached 16 points. Positive quantitative dynamics in scores were the characteristic of patients from both groups (advantage of the group I was insignificant (by 2 points) (p4<0.001)), although none of them reached the normal (32 points) at the final term (FU 4). Conclusion:Provided results proved the effectiveness of the developed rehabilitation protocol. It enhanced patients recovery up to 1-2 weeks.

Physiotherapy Rehabilitation Strategies for Post-operative Trimalleolar Ankle Fracture: A Case Report

The trimalleolar fracture of the ankle is the least common type of fracture among ankle fractures. This type of fracture occurs due to high-energy trauma and is seen mostly in females than males. In this case report, we present a 52-year-old female patient who met with a road accident 15 months before presentation. She was brought to the hospital for investigation and was diagnosed with a trimalleolar ankle fracture. She was managed with open reduction and internal fixation using rush nailing and canulated cancellous screws. There was pus discharge from the suture site post-operatively. Due to this, there was a delay in the weight-bearing phase. Medications were given for relief. Ten months post the operation she saw pus discharge from the scar site, she was re-operated for implant removal and physiotherapy was advised. Due to fear of pain, she was not bearing weight on that limb. This prolonged non-weight-bearing phase caused muscle wasting of the right leg, and reduced ankle dorsiflexion range and strength. The patient attended physiotherapy treatment. A Mulligan’s movement with mobilization was prescribed to increase the range of ankle dorsiflexion, and ultrasound was used to improve scar mobility. Strength training of lower limb muscles, proprioception training, and gait training was given to the patient. The treatment showed improvement in the range and strength of the lower limb. 

Measuring Recovery and Understanding Long-Term Deficits in Balance, Ankle Mobility and Hip Strength in People after an Open Reduction and Internal Fixation of Bimalleolar Fracture and Their Impact on Functionality: A 12-Month Longitudinal Study

To analyze how balance and other physical capacities evolved after surgery in patients with a bimalleolar fracture and how these capacities and clinical variables (immobilization or unloading time) contribute to restoring patients’ functionality, 22 patients and 10 healthy people (HC) were assessed for static and dynamic balance (Y-Balance test, YBT), dorsiflexion ankle mobility (ADFROM) and hip strength at 6 and 12 months after surgery. Patients’ functional status was assessed through the Olerud Molander Ankle Score (OMAS) and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Twenty-one patients with ankle fractures who completed the study showed a worse static and dynamic balance at 6 months. The YBT in the anterior direction (YBTA) revealed balance deficits in the operated limb at 12 months compared to the non-operated limb (−5.6%) and the HC (−6.7%). They also showed a decreased ADFROM compared to the non-operated limb (−7.4°) and the HC (−11°). In addition, medium-term (6 months) deficits in abductor strength hip but no hip strength deficits were found at 12 months after surgery. Relative weight analyses showed that ADFROM and hip strength explained 35–63% of the YBTA variance and AOFAS/OMAS scores. Balance, hip strength and ADFROM seem to be reliable indexes for assessing the functional status of these patients. These results could help to understand the relationship between these physical capacities and the patients’ perceived functional status.