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Active controlled motion in early rehabilitation improves outcome after ankle fractures

JANSEN H; JORDAN M; FREY S; HOLSCHER DOHT S; MEFFERT R; HEINTEL T
CLIN REHABIL , 2018, vol. 32, n° 3, p. 312-318
Doc n°: 187268
Localisation : Documentation IRR

D.O.I. : http://dx.doi.org/DOI:10.1177/0269215517724192
Descripteurs : DE741 - FRACTURES - CHEVILLE

OBJECTIVE: To evaluate the use of active controlled motion (ACM) after unstable
ankle fractures needing initial partial weight-bearing.
SETTING: Inpatient and outpatient clinic. SUBJECTS:
A total of 50 patients with unstable ankle fractures and the need for partial
weight-bearing for six weeks. INTERVENTIONS: Randomization in two groups:
physiotherapy alone or physiotherapy with an additional ACM device. MAIN
MEASURES: Follow-up after 6 and 12 weeks. Range of motion, visual analogue scale
for foot and ankle (VAS FA), Philip score, Mazur score, American Orthopaedic Foot
& Ankle Society (AOFAS) score and dynamic pedobarography. RESULTS: Range of
motion was better in the ACM group at six weeks (mean 49 degrees +/- 11.1 degrees
vs. 41.3 degrees +/- 8.1 degrees ). Questionnaires revealed better outcome after
six weeks in the VAS FA (56 +/- 13.7 vs. 40.6 +/- 10.5), Mazur score (64.4 +/-
12.3 vs. 56.7 +/- 11) and AOFAS score (71.2 +/- 12 vs. 63.6 +/- 8.7) ( P > 0.02
for all). Better outcome after 12 weeks in all questionnaires (VAS FA, 77.7 +/-
13.8 vs. 61.4 +/- 16.3; Philip score, 79.1 +/- 10.9 vs. 60.1 +/- 21.7; Mazur
score, 83.9 +/- 10.7 vs. 73.1 +/- 14.1; AOFAS score, 87.5 +/- 7.9 vs. 75.2 +/-
11.7) ( P < 0.01 for all). Pressure balance was better under the midfoot region
after 12 weeks in the ACM group (Delta P 4.4 N vs. 34.0 N; P = 0.01). The ACM
group had an earlier return to work after 10.5 (range, 3-17) versus 14.7 (range,
9-26) weeks ( P = 0.02). CONCLUSION: The use of ACM for patients needing initial
partial weight-bearing after operatively treated unstable ankle fractures in the
first six postoperative weeks leads to better clinical and functional results and
an earlier return to work.
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Langue : ANGLAIS

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