UNLABELLED

This report cites new developments in the treatment of extra-articular hand fractures in adults. Recent reports confirm that small amounts of metacarpal shortening or dorsal angulation cause minimal functional impairment. Unilateral excision of the lateral band and oblique fibers of the extensor apparatus of the metacarpophalangeal joint facilitates proximal phalangeal fracture exposure and may improve functional recovery. Results using open mini screw fixation of oblique extra-articular metacarpal and phalangeal fractures may be comparable to those of percutaneous Kirschner wire fixation. Bicortical self-tapping mini screw fixation of extra-articular oblique metacarpal and phalangeal fractures simplifies screw insertion and provides stability comparable to that of fractures fixed with lag screws. Percutaneous intramedullary wire fixation may afford suitable fixation for unstable extra-articular oblique as well as transverse metacarpal fractures. Locked intramedullary nails may offer similar advantages. Unicortical screw fixation of mini plates securing transverse extra-articular metacarpal fractures affords stability comparable to that of bicortical screw fixation while creating less bone damage. The dissection required for plate fixation and the small surface area of transverse fractures delay and occasionally impair bone healing. Primary bone grafting of diaphyseal defects in clean stable wounds may shorten and simplify treatment and decrease morbidity. As little as 1.7 mm of flexor tendon excursion during the first 4 weeks after reduction or repair may substantially diminish peritendonous adhesions at the fracture site. Synchronous wrist and digital exercises may also reduce peritendonous fracture adhesions. Early motion of adjacent joints in closed simple metacarpal fractures expedites recovery of motion and strength without adversely affecting fracture alignment and leads to earlier return to work.

LEVEL OF EVIDENCE

Level V (expert opinion).

INTRODUCTION

From a physiotherapist's point of view, helping patients recover from a distal end radius (DER) fracture is a big part of getting them back to their daily lives. This article highlights how important a structured, step-by-step rehabilitation program is for adults, whether their fracture was treated with a cast or with surgery. As physical therapists, our role is crucial in guiding this recovery, working closely with orthopedic surgeons.

MATERIALS AND METHODS

We understand that there is not one perfect exercise plan for every patient, but starting exercises early is always better. Our main goals are to reduce pain and swelling, improve how much the wrist and hand can move, and build up strength. We also focus on preventing common problems like stiffness or Complex Regional Pain Syndrome. We use tools like the Disability of Arm, Shoulder, and Hand and Michigan Hand Questionnaire scales to see how well patients are improving in their daily activities.

DISCUSSION

The rehabilitation is divided into phases. In the early phase, we focus on protecting the fracture while keeping other joints moving and managing swelling. As the bone heals, we introduce exercises to get the wrist moving more, improve muscle strength, and help with balance and coordination. We use various techniques, from gentle mobilizations to resistance exercises, and sometimes advanced therapies like electrical stimulation or mirror therapy to help patients along.

CONCLUSIONS

For patients who have had surgery, the rehab principles are similar, but we adjust the timing of exercises based on the surgeon's advice and the type of fixation. Ultimately, successful recovery is a team effort. When physical therapists and orthopedic surgeons work together, and the patient follows the plan, most people can regain good function and return to their normal activities after a DER fracture.

Copyright: © Indian Orthopaedic Research Group.

Weight-bearing physical activity may decrease or prevent bone deterioration after hip fracture. This study investigated the effects of a home-based physical rehabilitation program on tibial bone traits in older hip fracture patients. A population-based clinical sample of men and women operated for hip fracture (mean age 80 years, 78% women) was randomly assigned into an intervention (n = 40) and a standard care control group (n = 41) on average 10 weeks postfracture. The intervention group participated in a 12-month home-based rehabilitation intervention, including evaluation and modification of environmental hazards, guidance for safe walking, nonpharmacological pain management, motivational physical activity counseling, and a progressive, weight-bearing home exercise program comprising strengthening exercises for the lower legs, balance training, functional exercises, and stretching. All participants received standard care. Distal tibia (5% proximal to the distal end plate) compressive bone strength index (BSI; g2/cm4), total volumetric BMD (vBMDTOT; mg/cm3), and total area (CSATOT; mm2), as well as midtibia (55%) strength-strain index (SSI; mm3), cortical vBMD (vBMDCO; mg/cm3), and ratio of cortical to total area (CSACO/CSATOT) were assessed in both legs by pQCT at baseline and at 3, 6, and 12 months. The intervention had no effect (group × time) on either the distal or midtibial bone traits. At the distal site, BSI of both legs, vBMDTOT of the fractured side, and CSATOT of the nonfractured side decreased significantly over time in both groups 0.7% to 3.1% (12 months, p < 0.05). At the midshaft site, CSACO/CSATOT and SSI of both legs, and vBMDCO of the fractured leg, decreased significantly over time in both groups 1.1% to 1.9% (12 months, p < 0.05). Trabecular and cortical bone traits of the tibia on the fractured and the nonfractured side deteriorated throughout follow-up. The home-based physical rehabilitation intervention aimed at promoting mobility recovery was unable to prevent bone deterioration in older people after hip fracture. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

OBJECTIVE

Treating nonunion of the lateral humeral condyle with cubitus valgus deformity in children is challenging. While various surgical strategies exist, the role of a structured, standardized rehabilitation protocol in achieving optimal functional outcomes remains underexplored. This retrospective study aimed to evaluate the clinical and functional results of a two-stage surgical strategy (primary in situ fixation with bone grafting followed by secondary corrective osteotomy) coupled with a standardized, closely monitored rehabilitation protocol for pediatric lateral humeral condyle nonunion with cubitus valgus.

METHODS

A retrospective analysis was conducted on nine pediatric patients with humeral lateral condyle nonunion combined with cubitus valgus deformity who were treated at Honghui Hospital, Xi’an Jiaotong University, from January 2016 to March 2020. All underwent the two-stage surgery. In stage I, we performed debridement of the nonunion site, autologous iliac bone grafting, and in situ fixation using cannulated compression screws. Once bone union was achieved and elbow joint function had recovered, we performed corrective supracondylar medial closing wedge osteotomy to address the cubitus valgus deformity in stage II. The key focus of this study is the detailed, phase-specific rehabilitation protocol implemented after each stage: immobilization followed by graduated active-assisted and active range-of-motion exercises post-Stage I, and progressive resistance training post-Stage II. Elbow range of motion (ROM), carrying angle, and Mayo Elbow Performance Score (MEPS) were recorded and compared between the preoperative period and the final follow-up to evaluate treatment outcomes.

RESULTS

All patients were followed up postoperatively, with a mean duration of 45.5 months (range: 30–66 months). The mean time to union after the first-stage surgery for nonunion of lateral condyle fractures was 81.3 days (range: 55–120 days). All osteotomy sites in the second-stage corrective surgery achieved union, with an mean healing time of 51.1 days (range: 45–60 days). The elbow ROM improved significantly from a preoperative mean of 128.0° ± 4.6° to 138.5° ± 5.4° at the final follow-up (P < 0.001). The mean carrying angle of the unaffected side was 5.5° (range: 3°–8°). On the affected side, the carrying angle significantly improved from 31.8° ± 4.7° (range: 25°–42°) preoperatively to 4.0° ± 2.2° (range: 1°–8°) at final follow-up (P < 0.05). The MEPS improved from a preoperative mean of 58.5 ± 6.5 (4 fair, 5 poor) to 96.2 ± 3.4 (7 excellent, 2 good) at final follow-up (P < 0.05), indicating significant functional recovery. No avascular necrosis occurred. Transient hardware irritation occurred in one patient (11.1%).

CONCLUSION

The two-stage surgical approach, when integrated with a standardized, phased rehabilitation protocol, is an effective strategy for managing pediatric lateral humeral condyle nonunion with cubitus valgus, yielding significant functional improvements and reproducible outcomes.