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Scholl Schell M, Xavier de Araujo F, Silva MF. Physiotherapy assessment and treatment of patients with tibial external fixator: a systematic scoping review. Disabil Rehabil 2024; 46:1673-1684. [PMID: 37118977 DOI: 10.1080/09638288.2023.2202419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/08/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE To map evidence regarding physiotherapy assessment and treatment of patients with tibial external fixator (EF), and to point out literature gaps for further research. METHODS Systematic scoping review conducted in four databases. We included both experimental and non-experimental studies involving patients with tibial EF and outcomes of interest. We recorded study design, population, sample size, sample age, reason for EF use, type of surgery, type of EF used, instruments used for assessing function, pain, quality of life, satisfaction, psychosocial aspects, and physiotherapy treatment descriptions from included studies. We categorised data accordingly to outcomes assessed and physiotherapy treatments description. RESULTS Eighty-six studies were included involving 3070 patients. Causes of fixator use were traumatic conditions, acquired and congenital deformities, and non-traumatic conditions, like compartmental osteoarthritis. Function was assessed in about three-quarters of included studies, though other outcomes were not presented in most studies. Only one study described satisfactorily the physiotherapy treatment. Almost half of the studies did not provide any description of the rehabilitation process. CONCLUSIONS There is little evidence about the assessment of function, pain, quality of life, satisfaction, psychosocial aspects, and other outcomes in tibial EF patients. Physiotherapy treatment in these patients is poorly reported.Protocol registration: Open Science Framework: doi:10.17605/OSF.IO/UT2DA.
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Affiliation(s)
- Mauricio Scholl Schell
- Physiotherapy Department, Post Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | | | - Marcelo Faria Silva
- Physiotherapy Department, Post Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
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Su YC, Guo YH, Hsieh PC, Lin YC. Efficacy and safety of botulinum toxin type A in distraction osteogenesis of the lower extremities: a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 2022; 23:286. [PMID: 35337325 PMCID: PMC8953065 DOI: 10.1186/s12891-022-05175-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 03/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background To explore the efficacy and safety of botulinum toxin in patients who received distraction osteogenesis of the lower extremities. Methods We searched the PubMed, Medline, Cochrane Library, and Web of Science databases for randomized controlled trials that administered botulinum toxin to individuals who underwent distraction osteogenesis of the lower limbs. The final search was conducted on July 6, 2021. Quality assessments were conducted using the Cochrane risk of bias tool and the Jadad scale. We performed random-effects meta-analysis to calculate the standardized mean differences (SMDs) and confidence intervals (CIs) of the pooled effect sizes, and subgroup analysis and meta-regression were performed for potential moderators. Results Our analysis of four randomized controlled trials, which enrolled a total of 257 participants, revealed that the difference in pain during the distraction phase was not statistically significant between groups (SMD, − 0.165; 95% CI, − 0.379 to 0.050, p = 0.133, I2 = 0.0%). The meta-regression analyses did not find any influence on the effect size, considering age (β = − 0.0092; p = 0.61) and the amount of lengthening (β = 0.0023; p = 0.99). Subgroup analysis did not reveal difference between different doses of botulinum toxin and single or multi-site study design. An analysis of two randomized controlled trials enrolling a total of 177 individuals demonstrated a limited effect of botulinum toxin in reducing postoperative pain (SMD, − 0.239; 95% CI, − 0.641 to 0.162, p = 0.24, I2 = 37.6%), total adverse events (SMD, − 0.207; 95% CI, − 0.505 to 0.090, p = 0.17, I2 = 0.0%), and infection of pin site (SMD, − 0.131; 95% CI, − 0.428 to 0.165, p = 0.39, I2 = 0.0%). No botulinum toxin–related adverse events were reported. Conclusions The current evidence does not support the administration of botulinum toxin in patients who receive distraction osteogenesis of the lower limbs. However, we were unable to draw decisive conclusions because of the limitations of our meta-analysis. Future well-designed, large-scale randomized controlled trials are necessary to confirm our conclusions. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05175-2.
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Affiliation(s)
- Yu-Chi Su
- National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yao-Hong Guo
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Chun Hsieh
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Ching Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Tibial Lengthening Technique. Tech Orthop 2020. [DOI: 10.1097/bto.0000000000000459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wright J, Hill RA, Eastwood DM, Hashemi-Nejad A, Calder P, Tennant S. Posteromedial bowing of the tibia: a benign condition or a case for limb reconstruction? J Child Orthop 2018; 12:187-196. [PMID: 29707059 PMCID: PMC5902754 DOI: 10.1302/1863-2548.12.170211] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To review the initial deformity and subsequent remodelling in posteromedial bowing of the tibia and the outcome of limb reconstruction in this condition. PATIENTS AND METHODS In all, 38 patients with posteromedial bowing of the tibia presenting between 2000 and 2016 were identified. Mean follow-up from presentation was 78 months. A total of 17 patients underwent lengthening and deformity correction surgery, whilst three further patients are awaiting lengthening and deformity correction procedures. RESULTS The greatest correction of deformity occurred in the first year of life, but after the age of four years, remodelling was limited. The absolute leg-length discrepancy (LLD) increased throughout growth with a mean 14.3% discrepancy in tibial length. In the lengthening group, mean length gained per episode was 45 mm (35 to 60). Mean duration in frame was 192 days, with a mean healing index of 42.4 days/cm. Significantly higher rates of recurrence in LLD were seen in those undergoing lengthening under the age of ten years (p = 0.046). Four contralateral epiphysiodeses were also performed. CONCLUSION Posteromedial bowing of the tibia improves spontaneously during the first years of life, but in 20/38 (53%) patients, limb reconstruction was indicated for significant residual deformity and/or worsening LLD. For larger discrepancies and persistent deformity, limb reconstruction with a hexapod external fixator should be considered as part of the treatment options. LEVEL OF EVIDENCE Level IV (Case series).
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Affiliation(s)
- J. Wright
- Department of Orthopaedics, Great Ormond Street Hospital for Children, London, UK,Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, UK, Correspondence should be sent to J. Wright, Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, UK. E-mail:
| | - R. A. Hill
- Department of Orthopaedics, Great Ormond Street Hospital for Children, London, UK
| | - D. M. Eastwood
- Department of Orthopaedics, Great Ormond Street Hospital for Children, London, UK,Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - A. Hashemi-Nejad
- Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - P. Calder
- Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - S. Tennant
- Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, UK
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Abstract
Successful limb reconstruction surgery not only relies on surgical skill but probably more on assessment and planning before intervention. A clear appreciation of the child as a whole, an understanding of natural history and the ability to carefully evaluate the patient clinically are key to successful treatment. The appropriate use of investigations and the ability to analyze, plan and execute a treatment plan is challenging and requires experience and training. This paper outlines some of the steps required to assess the patient with a complex limb deformity.
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Abstract
A new generation of internal lengthening nail is now available that has reliable remote-controlled mechanisms. This allows accurate and well-controlled distraction rate and rhythm, and early clinical results have been very positive. In this article, 2 posttraumatic cases are presented that illustrate deformity correction and lengthening using the internal lengthening nail. Surgical planning and adjuvant techniques of fixator-assisted nailing and the use of blocking screws are discussed.
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Donnan LT, Gomes B, Donnan A, Harris C, Torode I, Heidt C. Ilizarov tibial lengthening in the skeletally immature patient. Bone Joint J 2017; 98-B:1276-82. [PMID: 27587532 DOI: 10.1302/0301-620x.98b10.37523] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 05/09/2016] [Indexed: 01/27/2023]
Abstract
AIMS We wished to examine the effectiveness of tibial lengthening using a two ring Ilizarov frame in skeletally immature patients. This is a potentially biomechanically unstable construct which risks the loss of axial control. PATIENTS AND METHODS We retrospectively reviewed a consecutive series of 24 boys and 26 girls, with a mean age of 8.6 years (4 to 14), who underwent 52 tibial lengthening procedures with a mean follow-up of 4.3 years (4.0 to 16.9). Tibial alignment was measured before and after treatment using joint orientation lines from the knee and a calculation of the oblique plane axis. RESULTS The mean percentage length gain was 20% (13 to 31) with a mean bone-healing index (BHI) of 34 days per centimetre (20 to 54). Age at surgery and location of the osteotomy site showed a strong relationship as the location of the osteotomy migrated more proximally with age. However, no significant correlation was found between BHI and the position of the osteotomy. The coronal and sagittal joint orientation of the lengthened tibias were within the normal range in 67% and 92% of cases, respectively. The oblique plane angulation calculation revealed a statistically significant change pre- to post-operatively in both magnitude (p < 0.05) and direction (p < 0.01), but without clinical consequence. The majority of complications were minor (n = 40 in 27 patients; 1.48 complications per segment lengthened) with no residual disability reported. CONCLUSION Two-ring tibial lengthening is effective in maintaining segmental alignment, efficient in callous production and relatively comfortable for the patient with few significant complications. Cite this article: Bone Joint J 2016;98-B:1276-82.
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Affiliation(s)
- L T Donnan
- The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - B Gomes
- The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - A Donnan
- The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - C Harris
- The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - I Torode
- The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - C Heidt
- The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia
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Mundell BF, Kremers HM, Visscher S, Hoppe KM, Kaufman KR. Predictors of Receiving a Prosthesis for Adults With Above-Knee Amputations in a Well-Defined Population. PM R 2015; 8:730-7. [PMID: 26690021 DOI: 10.1016/j.pmrj.2015.11.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/23/2015] [Accepted: 11/27/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Prior studies have identified age as a factor in determining an individual's likelihood of receiving a prosthesis following a lower limb amputation. These studies are limited to specific subsets of the general population and are unable to account for preamputation characteristics within their study populations. Our study seeks to determine the effect of preamputation characteristics on the probability of receiving a prosthesis for the general population in the United States. OBJECTIVE To identify preamputation characteristics that predict of the likelihood of receiving a prosthesis following an above-knee amputation. DESIGN A retrospective, population-based cohort study. SETTING Olmsted County, Minnesota (2010 population: 144,248). PARTICIPANTS Individuals (n = 93) over the age of 18 years who underwent an above-knee amputation, that is, knee disarticulation or transfemoral amputation, while residing in Olmsted County, MN, between 1987 and 2013. METHODS Characteristics affecting the receipt of a prosthesis were analyzed using a logistic regression and a random forest algorithm for classification trees. Preamputation characteristics included age, gender, amputation etiology, year of amputation, mobility, cognitive ability, comorbidities, and time between surgery and the prosthesis decision. MAIN OUTCOME MEASURES The association of preamputation characteristics with the receipt of a prosthesis following an above-knee amputation. RESULTS Twenty-four of the participants received a prosthesis. The odds of receiving a prosthesis were almost 30 times higher in those able to walk independently prior to an amputation relative to those who could not walk independently. A 10-year increase in age was associated with a 53.8% decrease in the likelihood of being fit for a prosthesis (odds ratio = 0.462, P =.030). Time elapsed between surgery and the prosthesis decision was associated with a rise in probability of receiving a prosthesis for the first 3 months in the random forest algorithm. No other observed characteristics were associated with receipt of a prosthesis. CONCLUSIONS The association of preamputation mobility and age with the likelihood of being fit for a prosthesis is well understood. The effect of age, after controlling for confounders, still persists and is associated with the likelihood of being fit for a prosthesis.
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Affiliation(s)
| | - Hilal Maradit Kremers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN(†)
| | - Sue Visscher
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN(‡)
| | - Kurtis M Hoppe
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN(§)
| | - Kenton R Kaufman
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester 55905, MN(‖)(#).
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Sabharwal S, Nelson SC, Sontich JK. What's New in Limb Lengthening and Deformity Correction. J Bone Joint Surg Am 2015; 97:1375-84. [PMID: 26290092 DOI: 10.2106/jbjs.o.00298] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sanjeev Sabharwal
- Department of Orthopedics, Rutgers-New Jersey Medical School, 90 Bergen Street, Doctor's Office Center, Suite 7300, Newark, NJ 07103. E-mail address for S. Sabharwal:
| | - Scott C Nelson
- Department of Orthopaedic Surgery, Loma Linda University, 11406 Loma Linda Drive, Suite 214A, Loma Linda, CA 92354
| | - John K Sontich
- MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109
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