Rehabilitation treatment protocol for perioperative accelerated rehabilitation of Pilon fractures_West China Medical Journal

Authors：

MENG Wei , QI Shizong ,  HE Chengqi

Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

HE Chengqi, Email: hxkfhcq@126.com

Keywords：

Pilon fracture; rehabilitation treatment; accelerated rehabilitation

DOI：

10.7507/1002-0179.202203098

Video：

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Pilon fracture is one of the most common and complex fractures in clinic. It has many postoperative complications, such as limitation of motion, pain, swelling, and decreased muscle strength. Complications will seriously affect patients’ ankle function. If the accelerated rehabilitation support can be obtained, patients can obtain a good functional recovery in the later stage. At present, there are few reports on enhanced rehabilitation related to Pilon fractures. This article introduces the rehabilitation treatment protocol for perioperative accelerated rehabilitation of Pilon fractures, mainly including rehabilitation evaluation, preoperative rehabilitation and postoperative rehabilitation treatment, aiming to provide some reference for standardizing the rehabilitation treatment of Pilon fractures in the perioperative period.

Citation： MENG Wei, QI Shizong, HE Chengqi. Rehabilitation treatment protocol for perioperative accelerated rehabilitation of Pilon fractures. West China Medical Journal, 2022, 37(5): 765-770. doi: 10.7507/1002-0179.202203098 Copy

1.	Ahmed AA, Singer MS, El Bigawi HA. Neglected tibial pilon fractures: can arthrodesis be avoided?. J Orthop Trauma, 2018, 32(7): 369-375.
2.	Tarkin IS, Clare MP, Marcantonio A, et al. An update on the management of high-energy pilon fractures. Injury, 2008, 39(2): 142-154.
3.	Ho B, Ketz J. Primary arthrodesis for tibial pilon fractures. Foot Ankle Clin, 2017, 22(1): 147-161.
4.	Egol KA, Dolan R, Koval KJ. Functional outcome of surgery for fractures of the ankle. A prospective, randomised comparison of management in a cast or a functional brace. J Bone Joint Surg Br, 2000, 82(2): 246-249.
5.	Lin CW, Moseley AM, Herbert RD, et al. Pain and dorsiflexion range of motion predict short- and medium-term activity limitation in people receiving physiotherapy intervention after ankle fracture: an observational study. Aust J Physiother, 2009, 55(1): 31-37.
6.	Devoogdt N, Cavaggion C, Van der Gucht E, et al. Reliability, validity, and feasibility of water displacement method, figure-of-eight method, and circumference measurements in determination of ankle and foot edema. Lymphat Res Biol, 2019, 17(5): 531-536.
7.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
8.	陳梅花, 陳樹清, 羅時運, 等. 平衡功能強化訓練聯合常規康復治療踝關節功能障礙的效果研究. 中國醫藥科學, 2019, 9(9): 19-22.
9.	董伊隆, 錢約男, 林凌志, 等. 多模式功能訓練治療功能性踝關節不穩的療效觀察. 中華物理醫學與康復雜志, 2019, 41(4): 296-298.
10.	De Houwer J, Tanaka A, Moors A, et al. Kicking the habit: why evidence for habits in humans might be overestimated. Motiv Sci, 2018, 4(1): 50-59.
11.	高博, 楊靈, 汪紅, 等. 跟骨牽引與外固定架臨時固定分步延期治療 C 型 Pilon 骨折的病例對照研究. 中國骨傷, 2020, 33(3): 203-208.
12.	史智偉, 周鳴, 劉磊. Ⅱ、Ⅲ型 Pilon 骨折治療手術時機的選擇. 臨床骨科雜志, 2012, 15(2): 183-184.
13.	Mair O, Pflüger P, Hoffeld K, et al. Management of pilon fractures-current concepts. Front Surg, 2021, 8: 764232.
14.	Jansen H, Jordan M, Frey S, et al. Active controlled motion in early rehabilitation improves outcome after ankle fractures: a randomized controlled trial. Clin Rehabil, 2018, 32(3): 312-318.
15.	黃一拯, 萬里洋, 徐丹, 等. Pilon 骨折術后康復中階梯式踝關節鍛煉. 創傷外科雜志, 2020, 22(5): 363-366.
16.	李路雪, 孫雪華. Pilon 骨折術后康復治療研究進展. 中國康復, 2021, 36(2): 121-124.
17.	Lee B, Schug SA, Joshi GP, et al. Procedure-specific pain management (PROSPECT) - an update. Best Pract Res Clin Anaesthesiol, 2018, 32(2): 101-111.
18.	Leland NE, Lepore M, Wong C, et al. Delivering high quality hip fracture rehabilitation: the perspective of occupational and physical therapy practitioners. Disabil Rehabil, 2018, 40(6): 646-654.
19.	Kwong LM. Deep vein thrombosis prophylaxis: better living through chemistry--in the affirmative. J Arthroplasty, 2005, 20(Suppl 2): 12-14.
20.	李艷, 黃兆民. 制動對骨骼肌的影響及機制. 中國康復理論與實踐, 2006, 12(12): 1024-1025.
21.	Meena UK, Bansal MC, Behera P, et al. Evaluation of functional outcome of pilon fractures managed with limited internal fixation and external fixation: a prospective clinical study. J Clin Orthop Trauma, 2017, 8(Suppl 2): S16-S20.
22.	Wainwright TW, Immins T, Antonis JHA, et al. Can the introduction of enhanced recovery after surgery (ERAS) reduce the variation in length of stay after total ankle replacement surgery?. Foot Ankle Surg, 2019, 25(3): 294-297.
23.	劉欣, 王磊, 陳先, 等. 早期介入康復治療對 Pilon 骨折手術后踝關節功能的影響. 中國康復醫學雜志, 2014, 29(3): 269-271.
24.	Donohoe E, Roberts HJ, Miclau T, et al. Management of lower extremity fractures in the elderly: a focus on post-operative rehabilitation. Injury, 2020, 51(Suppl 2): S118-S122.
25.	Kottmeier SA, Madison RD, Divaris N. Pilon fracture: preventing complications. J Am Acad Orthop Surg, 2018, 26(18): 640-651.
26.	李路雪, 裴夢鴿, 彭玲, 等. 早期負重鍛煉對后 Pilon 骨折術后愈合及踝關節功能影響. 臨床醫學進展, 2020, 10(8): 1862-1867.
27.	Ballal A, Rai HR, Shetty SM, et al. A prospective study on functional outcome of internal fixation of tibial pilon fractures with locking plate using minimally invasive plate osteosynthesis technique. J Clin Diagn Res, 2016, 10(1): RC01-RC04.
28.	Pawik ?, Pawe? W, Artur L, et al. Gait symmetry analysis in patients after treatment of pilon fractures by the ilizarov method. Symmetry, 2021, 13(2): 349.
29.	Marcus MS, Yoon RS, Langford J, et al. Is there a role for intramedullary nails in the treatment of simple pilon fractures? Rationale and preliminary results. Injury, 2013, 44(8): 1107-1111.
30.	Kerkhoffs GM, van den Bekerom M, Elders LA, et al. Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline. Br J Sports Med, 2012, 46(12): 854-860.
31.	史長安, 劉麗, 王建偉. 早期負重對距骨骨軟骨病損關節鏡下修復術后關節功能恢復影響的前瞻性研究. 中國骨與關節雜志, 2020, 9(9): 703-707.
32.	Stevens JE, Walter GA, Okereke E, et al. Muscle adaptations with immobilization and rehabilitation after ankle fracture. Med Sci Sports Exerc, 2004, 36(10): 1695-1701.
33.	Smeeing DP, Houwert RM, Briet JP, et al. Weight-bearing and mobilization in the postoperative care of ankle fractures: a systematic review and meta-analysis of randomized controlled trials and cohort studies. PLoS One, 2015, 10(2): e0118320.
34.	van der Vliet QMJ, Ochen Y, McTague MF, et al. Long-term outcomes after operative treatment for tibial pilon fractures. OTA Int, 2019, 2(4): e043.

1. Ahmed AA, Singer MS, El Bigawi HA. Neglected tibial pilon fractures: can arthrodesis be avoided?. J Orthop Trauma, 2018, 32(7): 369-375.
2. Tarkin IS, Clare MP, Marcantonio A, et al. An update on the management of high-energy pilon fractures. Injury, 2008, 39(2): 142-154.
3. Ho B, Ketz J. Primary arthrodesis for tibial pilon fractures. Foot Ankle Clin, 2017, 22(1): 147-161.
4. Egol KA, Dolan R, Koval KJ. Functional outcome of surgery for fractures of the ankle. A prospective, randomised comparison of management in a cast or a functional brace. J Bone Joint Surg Br, 2000, 82(2): 246-249.
5. Lin CW, Moseley AM, Herbert RD, et al. Pain and dorsiflexion range of motion predict short- and medium-term activity limitation in people receiving physiotherapy intervention after ankle fracture: an observational study. Aust J Physiother, 2009, 55(1): 31-37.
6. Devoogdt N, Cavaggion C, Van der Gucht E, et al. Reliability, validity, and feasibility of water displacement method, figure-of-eight method, and circumference measurements in determination of ankle and foot edema. Lymphat Res Biol, 2019, 17(5): 531-536.
7. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
8. 陳梅花, 陳樹清, 羅時運, 等. 平衡功能強化訓練聯合常規康復治療踝關節功能障礙的效果研究. 中國醫藥科學, 2019, 9(9): 19-22.
9. 董伊隆, 錢約男, 林凌志, 等. 多模式功能訓練治療功能性踝關節不穩的療效觀察. 中華物理醫學與康復雜志, 2019, 41(4): 296-298.
10. De Houwer J, Tanaka A, Moors A, et al. Kicking the habit: why evidence for habits in humans might be overestimated. Motiv Sci, 2018, 4(1): 50-59.
11. 高博, 楊靈, 汪紅, 等. 跟骨牽引與外固定架臨時固定分步延期治療 C 型 Pilon 骨折的病例對照研究. 中國骨傷, 2020, 33(3): 203-208.
12. 史智偉, 周鳴, 劉磊. Ⅱ、Ⅲ型 Pilon 骨折治療手術時機的選擇. 臨床骨科雜志, 2012, 15(2): 183-184.
13. Mair O, Pflüger P, Hoffeld K, et al. Management of pilon fractures-current concepts. Front Surg, 2021, 8: 764232.
14. Jansen H, Jordan M, Frey S, et al. Active controlled motion in early rehabilitation improves outcome after ankle fractures: a randomized controlled trial. Clin Rehabil, 2018, 32(3): 312-318.
15. 黃一拯, 萬里洋, 徐丹, 等. Pilon 骨折術后康復中階梯式踝關節鍛煉. 創傷外科雜志, 2020, 22(5): 363-366.
16. 李路雪, 孫雪華. Pilon 骨折術后康復治療研究進展. 中國康復, 2021, 36(2): 121-124.
17. Lee B, Schug SA, Joshi GP, et al. Procedure-specific pain management (PROSPECT) - an update. Best Pract Res Clin Anaesthesiol, 2018, 32(2): 101-111.
18. Leland NE, Lepore M, Wong C, et al. Delivering high quality hip fracture rehabilitation: the perspective of occupational and physical therapy practitioners. Disabil Rehabil, 2018, 40(6): 646-654.
19. Kwong LM. Deep vein thrombosis prophylaxis: better living through chemistry--in the affirmative. J Arthroplasty, 2005, 20(Suppl 2): 12-14.
20. 李艷, 黃兆民. 制動對骨骼肌的影響及機制. 中國康復理論與實踐, 2006, 12(12): 1024-1025.
21. Meena UK, Bansal MC, Behera P, et al. Evaluation of functional outcome of pilon fractures managed with limited internal fixation and external fixation: a prospective clinical study. J Clin Orthop Trauma, 2017, 8(Suppl 2): S16-S20.
22. Wainwright TW, Immins T, Antonis JHA, et al. Can the introduction of enhanced recovery after surgery (ERAS) reduce the variation in length of stay after total ankle replacement surgery?. Foot Ankle Surg, 2019, 25(3): 294-297.
23. 劉欣, 王磊, 陳先, 等. 早期介入康復治療對 Pilon 骨折手術后踝關節功能的影響. 中國康復醫學雜志, 2014, 29(3): 269-271.
24. Donohoe E, Roberts HJ, Miclau T, et al. Management of lower extremity fractures in the elderly: a focus on post-operative rehabilitation. Injury, 2020, 51(Suppl 2): S118-S122.
25. Kottmeier SA, Madison RD, Divaris N. Pilon fracture: preventing complications. J Am Acad Orthop Surg, 2018, 26(18): 640-651.
26. 李路雪, 裴夢鴿, 彭玲, 等. 早期負重鍛煉對后 Pilon 骨折術后愈合及踝關節功能影響. 臨床醫學進展, 2020, 10(8): 1862-1867.
27. Ballal A, Rai HR, Shetty SM, et al. A prospective study on functional outcome of internal fixation of tibial pilon fractures with locking plate using minimally invasive plate osteosynthesis technique. J Clin Diagn Res, 2016, 10(1): RC01-RC04.
28. Pawik ?, Pawe? W, Artur L, et al. Gait symmetry analysis in patients after treatment of pilon fractures by the ilizarov method. Symmetry, 2021, 13(2): 349.
29. Marcus MS, Yoon RS, Langford J, et al. Is there a role for intramedullary nails in the treatment of simple pilon fractures? Rationale and preliminary results. Injury, 2013, 44(8): 1107-1111.
30. Kerkhoffs GM, van den Bekerom M, Elders LA, et al. Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline. Br J Sports Med, 2012, 46(12): 854-860.
31. 史長安, 劉麗, 王建偉. 早期負重對距骨骨軟骨病損關節鏡下修復術后關節功能恢復影響的前瞻性研究. 中國骨與關節雜志, 2020, 9(9): 703-707.
32. Stevens JE, Walter GA, Okereke E, et al. Muscle adaptations with immobilization and rehabilitation after ankle fracture. Med Sci Sports Exerc, 2004, 36(10): 1695-1701.
33. Smeeing DP, Houwert RM, Briet JP, et al. Weight-bearing and mobilization in the postoperative care of ankle fractures: a systematic review and meta-analysis of randomized controlled trials and cohort studies. PLoS One, 2015, 10(2): e0118320.
34. van der Vliet QMJ, Ochen Y, McTague MF, et al. Long-term outcomes after operative treatment for tibial pilon fractures. OTA Int, 2019, 2(4): e043.

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