Rehabilitation for ankle fractures

NewsBot · Dec 28, 2023

The Creation and Validation of an Ankle Bone Age Atlas and Data Predicting Remaining Ankle Growth
Pennock, Andrew T. et al
Journal of Pediatric Orthopaedics ():10.1097/BPO.0000000000002601, December 22, 2023. | DOI: 10.1097/BPO.0000000000002601

Background:
The purpose of the current study was 2-fold: (1) to create and validate an ankle bone age atlas spanning the pediatric and adolescent years and (2) to utilize this atlas in conjunction with distal tibia/fibular growth data as measured on serial radiographs to develop a predictive growth model for the lower extremity.

Methods:
Radiographs were surveyed to identify distinguishable, reproducible, radiographic features. Radiographic features of the tibia, fibula, hindfoot, and midfoot from 270 patients were identified and a “standard” for each age/sex was selected to create an atlas. A separate cohort of 90 ankle radiographs was selected to validate the atlas. A subcohort of 41 patients with left-hand radiographs within 3 months of ankle imaging was used to compare the 2 bone age approaches. Harris growth lines were evaluated in 304 serial images of the distal tibia to determine the remaining growth.

Results:
The distal tib/fib ossification centers provided the best age assessment for early childhood (male age: 1 to 8 y; female age: 1 to 4 y). The ossification/fusion of the calcaneal apophysis provided the best age assessment in the preadolescent stage (male age: 6 to 14 y; female age: 5 to 12 y). The closure of the distal tib/fib physes best determined skeletal maturity (male age: 14 to 16 y; female age: 12 to 14 y). The ankle atlas had excellent interobserver and intraobserver reliability (intraclass correlation coefficient=0.993, P<0.001 and 0.998, P<0.001), respectively. We found an excellent correlation between the patient’s chronologic age and ankle bone age (r=0.984; P<0.001). Ankle bone age assessment and Greulich and Pyle were correlated (rs=0.822, P<0.001). We found that males with a bone age of ≥15 years and females with a bone age of ≥13 years had ≤2 mm of residual growth of the distal tibia/fibula physes.

Conclusions:
bone age can be determined using ankle films ordered to assess/treat ankle injuries. This tool, along with our growth remaining table, may have important clinical implications when managing patients with ankle trauma with premature physeal closure.
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NewsBot · Dec 28, 2023

Osteoarthritis after an ankle fracture: we can't really avoid it

NewsBot · Jan 1, 2024

Assessing the content validity of the Manchester-Oxford Foot Questionnaire in surgically treated ankle fracture patients: a qualitative study
Michael Q Nguyen et al
J Orthop Surg Res. 2023 Dec 8;18(1):941

Background: Roughly 10% of fractures in adults are ankle fractures. These injuries are found in both sexes and present with different fracture characteristics. The treatment varies with the patients' biology and fracture type, and the goals are to restore stability, prevent pain and maintain ankle function. Clinicians generally use outcomes like assessment of radiography, pain level, or function. The use of patient-reported outcome measures is increasing, and the Manchester-Oxford Foot Questionnaire (MOXFQ) has been shown to have good measurement properties when validated in patients with foot and ankle disorders. However, the instrument has not been validated for ankle fracture patients. This study aims to assess the content validity of the items in MOXFQ in surgically treated ankle fracture patients.

Methods: A qualitative deductive design was used to investigate patients' response process of the MOXFQ. Individual interviews were conducted using cognitive interviewing based on the theoretical framework of the 4-step model by Tourangeau. Adult patients that were surgically treated for an ankle fracture between four weeks and 18 months were purposively sampled, and interviews followed a semi-structured interview guide. The predetermined categories were comprehension, retrieval, judgement, and response.

Results: Seventeen respondents (65% females) were interviewed. Respondents' age ranged from 27 to 76 years. Some of the respondents in the early recovery phase were limited by post-operative restrictions and did not find the items in the walking/standing domain relevant. Respondents that were allowed weight-bearing as tolerated (WBAT) were able to recall relevant information for most items. Respondents with time since surgery more than 12 months had less pain and remembered fewer relevant episodes in the recall period. Items in the social interaction domain contained ambiguous questions and were generally considered less important by respondents. The summary index score lacked important concepts in measuring overall quality of life.

Conclusions: Pain was a central concept in the post-operative recovery of ankle fracture patients. The MOXFQ-subscales for pain and walking/standing had acceptable content validity in patients that were allowed WBAT. The social interaction-subscale and the summary index score had insufficient content validity for this patient population.
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NewsBot · Feb 12, 2024

Validation of the Ankle Ligament Reconstruction-Return to Sports after Injury (ALR-RSI) Score as a Tool to Assess Psychological Readiness to Return to Sport in an Active Population After Ankle Fracture Surgery: A Cross-sectional Study
Ibrahim Saliba et al
December 25, 2023

Ankle injuries account for 15% to 25% of all sports injuries resulting in significant pain and loss of function. The purpose of this cross-sectional study was to validate a scale to help surgeons quantify the psychological readiness to Return To Sport (RTS) in patients undergoing ankle fracture surgery. ALR-RSI was used to assess the psychological readiness for RTS in athletic patients who underwent ankle fracture fixation between January 2020 and January 2021. Participants filled out ALR-RSI and 2 Patient-Related Outcome Measurement (PROM) tools: Olerud-Molander Ankle Score (OMAS) and Self-Reported Foot and Ankle Score (SEFAS). A total of 93 patients were included. There was a strong correlation between ALR-RSI and both OMAS and SEFAS, with Pearson coefficients of r = 0.58 and 0.53, respectively. ALR-RSI was significantly higher in the RTS group than in those who no longer practiced their main preinjury sport. Moreover, the discriminant validity of ALR-RSI (AUC = 0.81) was better than that of the SEFAS and OMAS (AUC = 0.64 and 0.65, respectively, p = .001). The intra-class correlation coefficient ρ of 0.94 showed excellent reproducibility. At an optimal cutoff value of 76.7, ALR-RSI had a sensitivity of 81% and a specificity of 75% with a Youden index of 0.56. In conclusion, ALR-RSI was a valid and reproducible tool to evaluate the psychological readiness for RTS in an active population after an ankle fracture. This score could help surgeons identify athletes who may have unfavorable postoperative outcomes and provide support on the ability to RTS.
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NewsBot · Jun 25, 2024

Partial weight-bearing following ankle fracture: what's the actual load in early recovery?
Tobias Peter Merkle et al
Arch Orthop Trauma Surg. 2024 Jun 20.

Purpose: This study investigates the learning efficacy for partial weight load before discharge as well as the impact of biofeedback during the learning process.

Methods: We monitored weight-bearing in 57 patients who had surgery for ankle fractures. Continuous measurements without and with biofeedback were performed in the early postoperative stage in order to, first, assess how well these patients could apply what they have learned before being discharged, and second, to examine the influence of biofeedback.

Results: Using conventional teaching methods, only about one-third of patients (36.8% on the ground and 29.2% on the stairs) were able to maintain a satisfactory load. One-fourth of the patients did not place any weight on their leg, which was shown to be due to excessive pain at the time of the measurement (p < 0.05). A further one-fourth loaded inadequately low, while the remainder loaded excessively. Patients benefited significantly from the activation of audio-visual biofeedback in real time. As a result, loads in a target zone between 15 and 30 kg could be significantly increased (p < 0.05).

Conclusion: We conclude that the majority of ankle fracture patients were unable to learn partial weight bearing in the early postoperative stage using traditional techniques. Additionally, each patient's ability to carry out a given loading varied. Using an audio-visual real-time biofeedback modality led to significantly improved performance. These findings support the proposed utility of audiovisual feedback in early rehabilitation. With the use of outpatient real-time biofeedback systems, therapists will be able to respond specifically to the needs of each individual patient.
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NewsBot · Jul 16, 2024

Comparison of four patient reported outcome measures in patients with ankle fracture: A study on patient preferences and psychometric properties
Per Hviid Gundtoft et al
Foot and Ankle Surgery; 14 July 2024

Background
The aim was to assess psychometric properties of Manchester Oxford Foot Questionnaire (MOXFQ), the Self-reported Foot and Ankle Score (SEFAS), the Olerud Molander Ankle Score (OMAS), and the Forgotten Joint Score (FJS) in adults with ankle fractures.

Methods
Patients received all four questionnaires 6, 12, 14, 24, 52, and 104 weeks following an ankle fracture. According to COSMIN guidelines, statistical tests were performed to assess floor- and ceiling effects, structural validity, construct validity and reliability. Cognitive interview was performed with 9 patients.

Results
MOXFQ showed best model fit in Confirmatory Factor Analysis. When testing construct validity, all hypotheses were accepted except for OMAS and FJS. All questionnaires had an almost perfect test-retest reliability (Interclass Correlation Coefficient 0.81 to 0.91) and Cronbach's alpha ranged from 0.76 to 0.95. MOXFQ was the best rated questionnaire.

Conclusion
All questionnaires performed well and we recommend MOXFQ for future use in ankle fracture studies.
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NewsBot · Aug 5, 2024

Functional assessment and influencing factors after staged functional training in patients with ankle fractures
Min-Qiong Fang
World J Clin Cases. 2024 Jul 26;12(21):4499-4507

Background: The recovery of limb function after ankle fracture surgery is a gradual process. The main purpose of implementing early functional exercise, joint mobility, muscle contraction function, passive ankle flexion and extension exercises, or physical factor therapy techniques is to achieve the rapid recovery of normal physiological limb function. However, currently the most effective rehabilitation training method is staged limb functional exercise, which promotes rapid recovery of limb function while preventing adverse consequences caused by overwork or insufficient training. Staged limb functional exercise divides the rehabilitation process into multiple stages, each of which has specific training objectives and contents. This method helps patients gradually restore limb function. Nevertheless, some patients still exhibit poor limb function after standardized exercise. Therefore, a functional evaluation should be performed to analyze the impact of staged functional training after ankle fracture surgery.

Aim: To perform a functional evaluation and determine the influencing factors of staged functional training in patients with ankle fracture.

Methods: A retrospective study enrolled 150 patients who underwent surgical treatment for ankle fracture from May 2020 to May 2022 at our hospital. Univariate and multivariate linear regression analyses were performed on general data, functional exercise compliance scale for orthopedic patients, Social Support Rating Scale (SSRS), American Orthopedic Foot and Ankle Score (AOFAS) Ankle-Hindfoot Score, and pain factors [serum bradykinin (BK), prostaglandin E2 (PGE2), 5-hydroxytryptamine (5-HT)].

Results: Based on the AOFAS Ankle-Hindfoot Scale, the cases were divided into the excellent function (n = 111) and ordinary function (n = 39) groups. Univariate analysis revealed that monthly family income, education level, diabetes mellitus, functional exercise compliance scale of orthopedic patients score, SSRS, BK, PGE2, and 5-HT significantly influenced limb function after ankle fracture (P < 0.05); Multiple linear regression analysis showed that the functional exercise compliance scale score, SSRS, BK, PGE2, and 5-HT were independent risk factors affecting functional performance after staged functional exercise (P < 0.05).

Conclusion: Exercise compliance, SSRS, and pain level are the independent risk factors affecting functional performance after staged functional training following ankle surgery. Clinical nursing care after ankle surgery should include analgesic and health education measures to ensure optimal recovery of limb function.
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NewsBot · Sep 8, 2024

A Retrospective Cohort Analysis Comparing the Costs of Ankle Fracture Fixation in Orthopaedics and Podiatry in a U.S. Medicare Limited Data Set
James Meyers et al
Foot Ankle Int. 2024 Sep 3

Background: Increasing overlap exists between surgeries performed by podiatrists and orthopaedic surgeons. Large-scale cost comparisons between the two are lacking despite the current climate of cost containment in health care. Using national Medicare data, we aimed to compare per-case Medicare payments between podiatrists and orthopaedic surgeons for ankle fracture fixation.

Methods: This retrospective cohort study included patients in an outpatient setting undergoing either unimalleolar, bimalleolar, or trimalleolar ankle fracture repair from the national Medicare Limited Data Set (2013-2019). Type of surgeon (podiatrist or orthopaedic surgeon) was determined using publicly available information. The primary outcome was total Medicare payments specific to the procedure, as a surrogate for cost. A subset analysis was also done to directly compare costs of orthopaedic surgeons to podiatric surgeons while excluding other fees (eg, hospital facility fees and surgery-related imaging payments). Additionally, patient demographics and hospital characteristics were compared to determine if any factors associated with costs may influence group differences. Univariable tests assessed significance of group differences.

Results: Overall, 16 927 unimalleolar, 17 244 bimalleolar, and 11 717 trimalleolar fracture repairs were included; 86.7% and 13.3%, 92.4% and 7.6%, and 92.2% and 7.8% were performed by an orthopaedic surgeon or podiatrist, respectively. Median age (70-71 years) and median Charlson-Deyo Comorbidity Index (0) did not significantly differ between patients treated by either surgeon type. Median procedure-specific Medicare payments for all 3 categories of ankle fracture repairs (uni-, bi-, trimalleolar) were significantly lower for orthopaedic surgeons compared to podiatrists: $4156 vs $4300, $4205 vs $4379, and $4396 vs $4525, respectively (all P < .001).

Conclusion: Our investigation using a national Medicare data set (2013-2019) found that the 3 types of ankle fractures (unimalleolar, bimalleolar, and trimalleolar) performed by orthopaedic surgeons in an outpatient setting were less expensive and that cost differences do not appear to be driven by patient characteristics. These results and further research into the causes of the cost differences may help improve the cost-effectiveness of ankle fracture surgery.
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NewsBot · Sep 26, 2024

Bone Mineral Density and Clinical Outcome after Ankle Fracture
Hyunseong Kang, Ho-Hyup Kim, Chaemoon Lim
J Bone Metab. 2024 Aug;31(3):228-235

Background: No gold standard exists for bone mineral density (BMD) measurement of the ankle. This study aimed to determine the correlation between bone density using Hounsfield units (HU) based on computed tomography (CT) and BMD using dual energy X-ray absorptiometry (DXA) as well as to evaluate the correlation between HU and clinical outcome of ankle fracture.

Methods: Fifty-one patients aged ≥65 years who underwent surgical treatment for trimalleolus or bimalleolus ankle fractures were included. The HU were measured at the distal tibia metaphyseal region approximately 1 cm proximal to the plafond on the axial images of preoperative CT. BMD was measured using DXA within one year before the injury. The clinical outcome was evaluated according to the Foot and Ankle Outcome Score (FAOS).

Results: Although the HU of an osteoporosis group was lower than that of a non-osteoporosis group, we observed no significant difference between the two groups. The mean HU significantly correlated with the lumbar and total lumbar spine BMD using DXA. Increased HU significantly correlated with improved clinical outcomes in three of five FAOS subscales: symptoms, pain, activity of daily living (ADL), and quality of life (QOL). In a linear regression analysis adjusted for age and body mass index, increased HU significantly correlated with improved clinical outcomes in three of five FAOS subscales: symptoms, pain, ADL, and QOL.

Conclusions: The correlations between bone density using HU and BMD and those between HU and the clinical outcome were confirmed in ankle fractures. The HU of preoperative CT might provide valuable information for predicting postoperative clinical outcomes.
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NewsBot · Oct 5, 2024 at 12:58 AM

Multivariate analysis of influencing functional recovery after ankle fracture of typeⅡand above supination-external rotation
Chun-Gui Huang et al
Zhongguo Gu Shang. 2024 Sep 25;37(9):910-6

Objective: To explore influencing factors of functional recovery after ankle fracture of typeⅡdegree and above supination-external rotation.

Methods: Clinical data of 120 patients with ankle fractures of typeⅡdegree and above supination-external rotation admitted from February 2019 to April 2021 were retrospectively analyzed. According to American Orthopaedic Foot and Ankle Society (AOFAS), patients were divided into excellent group with 73 patients (90 to 100 points), good group with 35 patients (75 to 89 points), and fair group with 12 patients(<50 points). The differences of ankle active range of motion (ROM) and AOFAS score were compared among three groups at the latest follow-up. Multivariate Logistic regression analysis was performed to analyze the factors related to functional recovery after ankle fracture of supination-external rotation.

Results: There were significant differences in postoperative ROM (dorsoextension, plantar flexion, varus and valgus) and complications between excellent group and good and acceptable group (P<0.05). Univariate analysis showed there were differences in age above 50 years old, Ⅳ degree of supination-external rotation fracture, lower tibiofibular ligament injury, posterior ankle fracture, no drainage tube placed, infection, antibiotic use time above 7 days (P<0.05). Multivariate Logistic regression analysis showed age above 50 years old[OR=2.829, 95%CI(1.049, 7.628), P=0.040], Ⅳ degree fracture of supination-external rotation[OR=6.13, 95%CI(1.153, 32.593), P=0.033], lower tibiofibular ligament injury[OR=10.785, 95%CI(3.338, 34.894), P=0.000], and posterior ankle fracture[OR=6.349, 95%CI(1.869, 21.560), P=0.003] were independent risk factors for functional recovery after ankle fracture of supination-external rotation (P<0.05).

Conclusion: The postoperative excellent outcome of ankle fracture was good, and the recovery of joint motion was better. The older age of patient, Ⅳ degree of supination-external rotation fracture, the lower tibiofibular ligament injury, and posterior ankle fracture are all adverse factors affecting functional recovery after supination-external rotation ankle fracture. In clinical, effective measures should be taken to deal with these influencing factors, and strive to improve the functional recovery after the operation of this type of fracture and reduce the occurrence of related complications.
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Rehabilitation for ankle fractures

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Rehabilitation for ankle fractures

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Rehabilitation exercises for ankle athrodesis

Ankle Rehabilitation

Sports and Rehabilitation Podiatry job

How much is enough in rehabilitation?

Wearable devices in the prevention and rehabilitation of running related injuries

Tendon neuroplastic training: changing the way we think about tendon rehabilitation

Achilles tendinopathy: A prospective study on the effect of active rehabilitation and steroid inject

Share This Page

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