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Meijer HA, Obdeijn MC, van Loon J, van den Heuvel SB, van den Brink LC, Schijven MP, Goslings JC, Schepers T. Rehabilitation after Distal Radius Fractures: Opportunities for Improvement. J Wrist Surg 2023; 12:460-473. [PMID: 37841352 PMCID: PMC10569825 DOI: 10.1055/s-0043-1769925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/09/2023] [Indexed: 10/17/2023]
Abstract
Background Exercises are frequently prescribed to regain function; yet there is no consensus on a standardized protocol, and adherence is low. Smart technology innovations, such as mobile applications, may be useful to provide home-based patient support in rehabilitation after distal radius fractures. Purposes Our purpose was to establish the potential of digital innovations for support and monitoring of patients and treatment adherence in rehabilitation programs, and additionally, to compare the current practice among physiotherapists to the various wrist exercise regimens and their effectiveness as described in the literature. Methods Standard practice, including the use of support tools for treatment adherence, was evaluated using a nationwide survey. Then, scientific databases were searched using "distal radius fracture" and "physiotherapy" or "exercise therapy," and related search terms, up until 23 March 2023. Results of the survey and literature review were compared. Results The survey was completed by 92 therapists. Nonstandardized support tools were used by 81.6% of respondents; 53.2% used some form of technology, including taking photos on the patients' smartphone for home reference. In the literature review, 23 studies were included, of which five described an exercise protocol. Treatment adherence was not reported in any of the included studies. Two studies described the use of smart technology or support tools. Conclusions There is no consensus on a standardized exercise protocol for rehabilitation after distal radius fractures, neither from a systematic literature search nor from a nationwide survey. Smart technology may facilitate monitoring of patients and exercise adherence, hereby supporting self-efficacy and improving adherence and outcomes.
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Affiliation(s)
- Henriëtte A.W. Meijer
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Miryam C. Obdeijn
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Justin van Loon
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | | | - Lianne C. van den Brink
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Marlies P. Schijven
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism, Amsterdam, The Netherlands
| | - J. Carel Goslings
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, The Netherlands
| | - Tim Schepers
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Da H, Zhou L, Xi QY, Xu CM. Modified lateral approach combined with medial percutaneous approach versus triceps tongue-shaped flap approach and bilateral triceps brachii approach for pin fixation in treatment of irreducible displaced pediatric supracondylar humeral fractures. Medicine (Baltimore) 2023; 102:e35158. [PMID: 37682149 PMCID: PMC10489252 DOI: 10.1097/md.0000000000035158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023] Open
Abstract
To evaluate the clinical outcomes of the modified lateral approach combined with the medial percutaneous approach (MLACMPA) versus the triceps tongue-shaped flap approach (TTSFA) and the bilateral triceps brachii approach (BTBA) in the treatment of irreducible displaced supracondylar humeral fractures (SHFs) in children. Between March 2000 and July 2022, a total of 135 children who underwent open reduction and Kirschner wire cross internal fixation for irreducible displaced SHFs caused by trauma were retrospectively analyzed. According to the surgical approach, the patients were assigned to the TTSFA group (n = 36), the BTBA group (n = 40) and the MLACMPA group (n = 59). The duration of surgery, intraoperative blood loss, incision length, and elbow range of motion were compared. The 3 groups were similar in terms of mean age, sex distribution, and time from injury to operation. The duration of surgery, intraoperative blood loss, incision length and postoperative elbow range of motion in the MLACMPA group were significantly superior to those in the TTSFA group and BTBA group (P < .05). Compared the use of the TTSFA or the BTBA, using the MLACMPA for pin fixation in the treatment of irreducible displaced pediatric SHFs could significantly shorten the duration of surgery, reduce the operation trauma, facilitate earlier functional exercise of joints after operation and yield better elbow function.
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Affiliation(s)
- Hu Da
- Department of Orthopaedics, Lianshui County People’s Hospital, Lianshui, China
| | - Liang Zhou
- Department of Orthopaedics, Lianshui County People’s Hospital, Lianshui, China
| | - Qiao-Yun Xi
- Department of Orthopaedics, Lianshui County People’s Hospital, Lianshui, China
| | - Chang-Ming Xu
- Department of Orthopaedics, Lianshui County People’s Hospital, Lianshui, China
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Naqvi WM, Qureshi MI. Rapid Synthesis of the Literature on the Evolution of Gamification in Distal Radial Fracture Rehabilitation. Cureus 2022; 14:e29382. [PMID: 36304351 PMCID: PMC9586187 DOI: 10.7759/cureus.29382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/20/2022] [Indexed: 11/05/2022] Open
Abstract
Distal radial fractures (DRF) are often encountered in upper limb fractures globally, and their associated complications affect the functional independence of the individual following the injury. The potential of gamification in applied rehabilitation is expanding its horizons in the rehabilitation of conditions ranging from neuromotor deficits to cognitive impairments. However, the synthesis of the literature is aimed at analyzing and summarizing the evolution of gamification in DRF rehabilitation. A comprehensive search and extraction of relevant literature were conducted and reviewed for the applicability of population analysis, interventional methodology, comparative factors, outcome measures, and the type of study. Thirteen studies were included and evaluated, including randomized controlled trials (RCTs), literature reviews, systematic reviews, meta-analyses, and bibliometric analyses. The conclusions demonstrated an improvement with gamification and addressed it as an effective rehabilitation method. Based on the analysis of the data that was extracted, the conclusion supports the use of gamification in the rehabilitation of DRF and looks into how it can help improve the person's functional capacity.
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Naqvi WM, Qureshi MI. Gamification in Therapeutic Rehabilitation of Distal Radial and Ulnar Fracture: A Case Report. Cureus 2022; 14:e28586. [PMID: 36185862 PMCID: PMC9521513 DOI: 10.7759/cureus.28586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 08/30/2022] [Indexed: 01/19/2023] Open
Abstract
Gamification is a novel interventional approach to functional recovery and rehabilitation. We present a novel gamification rehabilitation case of a 38-year-old female referred to the physiotherapy department for post-distal radial fracture rehabilitation. She was managed with closed reduction and internal fixation (CRIF) using two Kirschner wires (K-wires) after falling on an outstretched hand in a road traffic accident with a two-wheeler. Gamification intervention was provided to the patient for four weeks. We used pre- and post-intervention outcome measures for pain, range of motion, grip strength, and hand function. There was a substantial improvement in all outcome measures after four weeks of gamification intervention.
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De Vitis R, D'Orio M, Passiatore M, Perna A, Cilli V, Taccardo G. Elastic stable intramedullary fixation using epibloc versus crossed kirschner wires fixation for distal forearm fractures in children: A retrospective analysis. Afr J Paediatr Surg 2022; 19:153-159. [PMID: 35775516 PMCID: PMC9290372 DOI: 10.4103/ajps.ajps_178_20] [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] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Childrens' distal forearm fractures (DFFs) could be treated conservatively with closed reduction and immobilisation, but post-reduction displacements often occur. Displaced DFF should be surgically fixed, to avoid further displacement. Nevertheless, immobilisation after surgery is recommended. Epibloc system (ES), a system of stable elastic nail fixation, is widely used to stabilise adults extra-articular distal radius fractures, with advantages to not requiring post-surgical immobilisation. The present investigation represents a retrospective analysis of paediatric patients with DFF treated with ES applied with a minimal technical variation, to fix both ulna and radius fractures using a unique device. MATERIALS AND METHODS A retrospective analysis was performed on 44 children (age 6-11 years) who underwent closed reduction and internal fixation because of DFF (both ulna and radius). Group A (21 patients): ES fixation. Group B (23 patients): K-wires and short arm cast fixation. The primary outcome was the subsistence of reduction monitored through X-rays. The secondary outcome was the measurement of active range of motion (AROM) and the time of recovery. RESULTS No differences were observed comparing Group A and B in terms of the maintenance of reduction (P > 0.05). Seven days after the implant removal, patients in Group A reached significantly better results compared to patients in Group B in terms of AROM (P < 0.05). No differences were revealed in terms of complications between the two groups. CONCLUSION ES applied with a minimal technical variation is safe and effective in treating distal ulna and radius fractures, with minimal requirement of post-surgical rehabilitation.
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Affiliation(s)
- Rocco De Vitis
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco D'Orio
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Passiatore
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Perna
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vitale Cilli
- Hand Surgery Unit, CHIREC Site Delta, Bruxelles, Belgium
| | - Giuseppe Taccardo
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Pavone V, Vescio A, Accadbled F, Andreacchio A, Wirth T, Testa G, Canavese F. Current trends in the treatment of supracondylar fractures of the humerus in children: Results of a survey of the members of European Paediatric Orthopaedic Society. J Child Orthop 2022; 16:208-219. [PMID: 35800655 PMCID: PMC9254020 DOI: 10.1177/18632521221106379] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/19/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate the current trends in the treatment of supracondylar humerus fractures as well as the preferred post-operative follow-up protocol among members of the European Paediatric Orthopaedic Society. METHODS The survey was composed by four main domains and 26 items: (1) surgeon information (3 items); (2) treatment (8 items); (3) post-operative treatment (3 items); and (4) factors influencing the outcome (12 items). All active members of European Paediatric Orthopaedic Society were invited by email to answer an electronic questionnaire. RESULTS The survey was submitted to 397 European Paediatric Orthopaedic Society active members; 184 members answered (46.3%) the questionnaire. Among respondents, 64.1% declared >10 years of experience and 55.4% declared to treat >20 supracondylar humerus fractures per year. Closed reduction, percutaneous pinning, and supine position were the preferred treatment option for Gartland type II and III supracondylar humerus fractures by 79.9%, 95.5%, and 84.8% of respondents, respectively. Supracondylar humerus fractures are treated within 24 h from trauma by 33.2% of respondents. Pins are removed 4 weeks from index procedure by 58.2% of respondents. Fracture type (72.3%), surgeon experience, and (71.2%) are of "crucial importance" for expected outcome of supracondylar humerus fractures treatment. CONCLUSION Surgeon experience, type of fracture, treatment modality, and pins configuration were considered the main factors potentially influencing the outcome of supracondylar humerus fractures. European Paediatric Orthopaedic Society members agreed on the treatment modality of Gartland type II and III supracondylar humerus fractures, patient positioning, and timing of hardware removal. Other important issues such as timing of surgery, pins configuration, surgical approach, and post-operative protocol are still debated. LEVEL OF EVIDENCE level II.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and
Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University
Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy,Vito Pavone, Department of General Surgery
and Medical Surgical Specialties, Section of Orthopaedics and Traumatology,
University Hospital Policlinico-Vittorio Emanuele, University of Catania, Via
Santa Sofia 78, 95123 Catania, Italy.
| | - Andrea Vescio
- Department of General Surgery and
Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University
Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Franck Accadbled
- Pediatric Orthopaedic Department,
Purpan Hospital, Toulouse University Centre, Toulouse, France
| | - Antonio Andreacchio
- Pediatric Orthopedic Surgery
Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
| | - Thomas Wirth
- Orthopaedic Department, Olga Hospital,
Stuttgart, Germany
| | - Gianluca Testa
- Department of General Surgery and
Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University
Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Federico Canavese
- Department of Pediatric Orthopedic
Surgery, Jeanne de Flandre Hospital, Lille University Centre, Lille, France
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Meijer HAW, Graafland M, Obdeijn MC, van Dieren S, Goslings JC, Schijven MP. Serious game versus standard care for rehabilitation after distal radius fractures: a protocol for a multicentre randomised controlled trial. BMJ Open 2021; 11:e042629. [PMID: 33785488 PMCID: PMC8030479 DOI: 10.1136/bmjopen-2020-042629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Distal radius fractures are among the most prevalent traumatic injuries worldwide. These injuries are associated with high healthcare-related and socioeconomic costs, mainly resulting from loss of productivity. To optimise recovery and return to work, wrist exercises are recommended. However, adherence to standard exercise regimens is low. Serious games provide a treatment platform for standardised postoperative care, uniting meaningful recovery with entertainment. Also, mobile serious games, for example, smartphone or tablet applications, are able to send practice reminders believed to improve self-efficacy. METHODS AND ANALYSIS To test the effectiveness of a mobile serious game for distal radius fracture rehabilitation compared with standard care, a multicentre, randomised controlled clinical trial was designed. Primary outcome will be the Patient-Rated Wrist Evaluation (PRWE) score after 6 weeks of treatment. Secondary outcomes are range of motion, grip strength, pain scores, and self-reported treatment adherence after 2, 6 and 12 weeks of treatment.Adult patients with any type of closed distal radius fracture are included directly after non-operative or operative fracture treatment. Patients are recruited in the outpatient clinics of four teaching hospitals. The intended sample size is 92 patients, based on the minimal clinically important difference of the PRWE score at 6 weeks, using a superiority model.Patients are randomised between using the wearable-controlled mobile serious game ReValidate! (intervention group) and standard care consisting of unsupervised exercises and a referral for physiotherapy or exercise therapy upon request or recommendation by the treating clinician (control group). ETHICS AND DISSEMINATION The protocol has been approved by the Medical Ethical Review Board of the Amsterdam University Medical Centres, location Academic Medical Centre in Amsterdam, the Netherlands. Results will be made available to involved healthcare providers, funders, and to the general public including patients via peer-reviewed academic journals and international conferences. TRIAL REGISTRATION NUMBER Dutch Trial Registry (NTR), NL6140, protocol V.2.
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Affiliation(s)
- Henriëtte A W Meijer
- Department of Surgery, Amsterdam Movement Sciences, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Maurits Graafland
- Department of Surgery, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Miryam C Obdeijn
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Susan van Dieren
- Department of Surgery, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - J Carel Goslings
- Department of Trauma Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Marlies P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
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Kachmar O, Kushnir A, Fedchyshyn B, Cristiano J, O'Flaherty J, Helland K, Johnson G, Puig D. Personalized balance games for children with cerebral palsy: A pilot study. J Pediatr Rehabil Med 2021; 14:237-245. [PMID: 33720857 DOI: 10.3233/prm-190666] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To assess the changes in balance function in children with cerebral palsy (CP) after two weeks of daily training with personalized balance games. METHODS Twenty-five children with CP, aged 5 to 18 years were randomly selected for experimental or control groups. Over a period of two weeks, all participants received 8-9 game sessions for 15-20 minutes, totaling 150-160 minutes. The experimental group used personalized balance games available from the GAmification for Better LifE (GABLE) online serious gaming platform. Children from the control group played Nintendo Wii games using a handheld Wii Remote. Both groups received the same background treatment. Recorded outcome measures were from a Trunk Control Measurement Scale (TCMS), Timed Up & Go Test (TUG), Center of Pressure Path Length (COP-PL), and Dynamic Balance Test (DBT). RESULTS After two weeks of training in the experimental group TCMS scores increased by 4.5 points (SD = 3.5, p< 0.05) and DBT results increased by 0.88 points (IQR = 1.03, p< 0.05) while these scores did not change significantly in the control group. Overall, TUG and COP-PL scores were not affected in either group. CONCLUSION This study demonstrates improvement of balancing function in children with CP after a two-week course of training with personalized rehabilitation computer games.
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Affiliation(s)
- Oleh Kachmar
- International Clinic of Rehabilitation, Truskavets, Ukraine
| | - Anna Kushnir
- International Clinic of Rehabilitation, Truskavets, Ukraine
| | | | | | - John O'Flaherty
- The National Microelectronics Applications Centre Ltd., Limerick, Ireland
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