SLR - February 2019 - Matthew Weintraub
Reference: Radiological Study of the Secondary Reduction Effect of Early Functional Exercise on Displaced Intra-Articular Calcaneal Fractures After Internal Compression Fixation. Chen, W., Liu, B., Lv, H. et al. International Orthopaedics (SICOT) (2017) 41: 1953. https://doi.org/10.1007/s00264-017-3533-zScientific Literature Review
Reviewed By: Matthew Weintraub DPM
Residency Program: University Hospital, Newark, NJ
Podiatric Relevance: With postoperative course constantly being a topic of debate in the podiatric world, this article’s purpose was to offer a possible explanation as to why early weightbearing, especially with regards to intra-articular calcaneal fractures, may lead to better overall outcomes. In a time when postoperative course seems to be trending toward earlier weightbearing and functional exercises, this study offers radiographic support as to one of the positive effects that early postoperative exercise and early weightbearing can have. A prospective study was to support the paper’s hypothesis.
Methods: From December 2012 to September 2013, patients with unilateral displaced intra-articular calcaneal fractures (DIACFs) were enrolled and received a treatment consisting of percutaneous leverage and minimally invasive fixation. After surgery, patients in the study group started exercising on days two to three, using partial weightbearing starting week three and full weightbearing starting week 12. Patients in the control (conservative) group followed a conventional postoperative protocol of partial weightbearing after week six and full weight bearing after the bone healed. Computed tomography was performed at postoperative intervals, day one, week four, week eight and week 12 to reconstruct coronal, sagittal and axial images, on which the maximal residual displacements of the fractures were measured. Overall function was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring scale at the 12th postoperative month.
Results: Twenty-eight patients from the study group and 32 from the control group were followed up for a period of greater than 12 months. The data from each time interval was collected and used for the final analysis. Repeated-measures analysis of variance of the maximal residual displacements of the fracture measured on CT images revealed statistically significant differences between the study and the control groups. With the exception of the first time interval (day one), the differences between the groups at all other studied time points were found to be statistically significant. In the study group, the differences between all studied time points were found to be statistically significant.
Conclusions: Early functional exercise and weightbearing activity can help reduce smaller nonfixated intra-articular calcaneal fracture fragments and thereby help to remodel and reshape the subtalar joint by reducing the residual displacement of the articular surface. This can ultimately lead to improving functional recovery of the operative foot. This study found a correlation between maximal residual displacement of the intra-articular calcaneal fractures and overall AOFAS scores at 12 months after surgery. This study revealed the impact that early rehab, functional exercise and earlier weightbearing can have on reducing the smaller DIACFs. Early rehabilitation, functional exercise and earlier weightbearing should be recommended in the clinical setting.