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.	陈梅花, 陈树清, 罗时运, 等. 平衡功能强化训练联合常规康复治疗踝关节功能障碍的效果研究. 中国医药科学, 2019, 9(9): 19-22.
9.	董伊隆, 钱约男, 林凌志, 等. 多模式功能训练治疗功能性踝关节不稳的疗效观察. 中华物理医学与康复杂志, 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, 杨灵, 汪红, 等. 跟骨牵引与外固定架临时固定分步延期治疗 C 型 Pilon 骨折的病例对照研究. 中国骨伤, 2020, 33(3): 203-208.
12.	史智伟, 周鸣, 刘磊. Ⅱ、Ⅲ型 Pilon 骨折治疗手术时机的选择. 临床骨科杂志, 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.	黄一拯, 万里洋, 徐丹, 等. Pilon 骨折术后康复中阶梯式踝关节锻炼. 创伤外科杂志, 2020, 22(5): 363-366.
16.	李路雪, 孙雪华. Pilon 骨折术后康复治疗研究进展. 中国康复, 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.	李艳, 黄兆民. 制动对骨骼肌的影响及机制. 中国康复理论与实践, 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.	刘欣, 王磊, 陈先, 等. 早期介入康复治疗对 Pilon 骨折手术后踝关节功能的影响. 中国康复医学杂志, 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, 裴梦鸽, 彭玲, 等. 早期负重锻炼对后 Pilon 骨折术后愈合及踝关节功能影响. 临床医学进展, 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 Ł, Paweł 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.	史长安, 刘丽, 王建伟. 早期负重对距骨骨软骨病损关节镜下修复术后关节功能恢复影响的前瞻性研究. 中国骨与关节杂志, 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. 陈梅花, 陈树清, 罗时运, 等. 平衡功能强化训练联合常规康复治疗踝关节功能障碍的效果研究. 中国医药科学, 2019, 9(9): 19-22.
9. 董伊隆, 钱约男, 林凌志, 等. 多模式功能训练治疗功能性踝关节不稳的疗效观察. 中华物理医学与康复杂志, 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, 杨灵, 汪红, 等. 跟骨牵引与外固定架临时固定分步延期治疗 C 型 Pilon 骨折的病例对照研究. 中国骨伤, 2020, 33(3): 203-208.
12. 史智伟, 周鸣, 刘磊. Ⅱ、Ⅲ型 Pilon 骨折治疗手术时机的选择. 临床骨科杂志, 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. 黄一拯, 万里洋, 徐丹, 等. Pilon 骨折术后康复中阶梯式踝关节锻炼. 创伤外科杂志, 2020, 22(5): 363-366.
16. 李路雪, 孙雪华. Pilon 骨折术后康复治疗研究进展. 中国康复, 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. 李艳, 黄兆民. 制动对骨骼肌的影响及机制. 中国康复理论与实践, 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. 刘欣, 王磊, 陈先, 等. 早期介入康复治疗对 Pilon 骨折手术后踝关节功能的影响. 中国康复医学杂志, 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, 裴梦鸽, 彭玲, 等. 早期负重锻炼对后 Pilon 骨折术后愈合及踝关节功能影响. 临床医学进展, 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 Ł, Paweł 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. 史长安, 刘丽, 王建伟. 早期负重对距骨骨软骨病损关节镜下修复术后关节功能恢复影响的前瞻性研究. 中国骨与关节杂志, 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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