Strategies in Trauma and Limb Reconstruction

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  19 (2024)
Volume  18 (2023)
Volume  17 (2022)
Volume  16 (2021)
Volume  15 (2020)
Volume  14 (2019)
Volume  13 (2018)
Volume  12 (2017)
Volume  11 (2016)
Volume  10 (2015)
Volume  9 (2014)
Volume  8 (2013)
Volume  7 (2012)
Volume  6 (2011)
Volume  5 (2010)
Volume  4 (2009)
Volume  3 (2008)
Volume  2 (2007)
Volume  1 (2006)
Related articles

VOLUME 19 , ISSUE 1 ( January-April, 2024 ) > List of Articles

REVIEW ARTICLE

Rehabilitation Techniques for Adults Undergoing External Fixation Treatment for Lower Limb Reconstruction: A Systematic Review

Jessica R Pawson, Daniel Church, Joanna Fletcher, Rebecca AL Wood, Catherine Hilton, James Lloyd, Jade Brien, Kathryn C Collins

Keywords : Circular frame, Ex-fix, External fixation, External fixator, Limb reconstruction, Lower limb fracture, Physiotherapy, Rehabilitation, Systematic review

Citation Information : Pawson JR, Church D, Fletcher J, Wood RA, Hilton C, Lloyd J, Brien J, Collins KC. Rehabilitation Techniques for Adults Undergoing External Fixation Treatment for Lower Limb Reconstruction: A Systematic Review. 2024; 19 (1):45-55.

DOI: 10.5005/jp-journals-10080-1609

License: CC BY-NC 4.0

Published Online: 06-05-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Introduction: External fixation devices are commonly used in orthopaedic surgery to manage a range of pathologies. In this patient population, there is currently no consensus on optimal rehabilitation techniques. There exists a large variation in practice, with a limited understanding of how these affect treatment outcomes. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a systematic review was conducted of Allied and Complementary Medicine Database (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PEDro, and COCHRANE databases, grey literature sources and forward and backward searching of included articles. Studies were selected following rigorous screening with predefined inclusion criteria. Data quality was assessed using validated appraisal tools. Articles were synthesised by rehabilitation type and descriptive analysis was subsequently performed. Results: From 1,156 articles identified, 18 were eligible for inclusion. The overall quality was low, with clinical commentaries and case studies being the most common study type. Studies were synthesised by rehabilitation type, the most common themes being gait re-education, strengthening, therapy-assisted, active exercises and weight-bearing exercises. Conclusion: There is a lack of high-quality evidence to support meaningful recommendations and guide rehabilitation practices for this patient cohort. Further research for patients being treated in external fixation, especially related to the potential effects of physical rehabilitation on bone healing, return of strength, mobility and independent function is likely to have transferability within wider orthopaedic populations. Clinical significance: This systematic review is unable to provide clinical recommendations due to the poor quality of the available literature. However, it is hoped this paper will provide a foundation for further research to improve rehabilitation for patients being treated with external fixation.

PDF Share
  1. Paul GW. The history of external fixation. Clin Podiatr Med Surg 2003;20(1):1–8. DOI: 10.1016/s0891-8422(02)00050-2.
  2. Boksh K, Kanthasamy S, Divall P, et al. Hexapod circular frame fixation for tibial non-union: A systematic review of clinical and radiological outcomes. Strategies Trauma Limb Reconstr 2022;17(3):172–183. DOI: 10.5005/jp-journals-10080-1570.
  3. Nicol S, Jackson M, Monsell F. Recent advances in external fixation. Bone & Joint 360 2015;4(4):2–7. DOI: 10.1302/2048-0105.42.360352.
  4. Frost HM. Wolff's Law and bone's structural adaptations to mechanical usage: An overview for clinicians. Angle Orthod 1994;64(3):175–188. DOI: 10.1043/0003-3219(1994)064<0175:WLABSA>2.0.CO;2.
  5. National Major Trauma Rehabilitation Group. NMTRG Guidelines for the assessment and rehabilitation of the major trauma patient. 2023. Available at: https://www.c4ts.qmul.ac.uk/downloads/nmtrg/nmtrg-mdt-lower-limb-reconstruction-guideline.pdf. Accessed on: 17 January 2023.
  6. Barker K, Burns M. Using consensus techniques to produce clinical guidelines for patients treated with Ilizarov Fixator. Physiotherapy 2001;87(6):289–300. DOI: 10.1016/S0031-9406(05)60763-8.
  7. Herzenberg JE, Scheufele LL, Paley D, et al. Knee range of motion in isolated femoral lengthening. Clin Orthop Relat Res 1994;301:49–54. PMID: 8156696.
  8. Schell MS, Xavier De Araujo F, Faria M, et al. Physiotherapy assessment and treatment of patients with tibial external fixator: A systematic scoping review. Disabil Rehabil 2023;1–12. DOI: 10.1080/09638288.2023.2202419.
  9. Higgins J, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions, Version 6.3. Cochrane Library, 2022. Available at: https://www.training.cochrane.org/handbook. Accessed on: 08 August 2022.
  10. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021;372:n71. DOI: 10.1136/bmj.n71.
  11. Ouzzani M, Hammady H, Fedorowicz Z, et al. Rayyan: A web and mobile app for systematic reviews. Syst Rev 2016;5(1):210. DOI: 10.1186/s13643-016-0384-4.
  12. Hong QN, Pluye P, Fabregues S, et al. Mixed Methods Assessment Tool (MMAT), Version 2018. Registration of Copyright (#1148552), Canadian Intellectual Property Office, Industry Canada. Available from: http://mixedmethodsappraisaltoolpublic.pbworks.com/w/file/.fetch/127916259/MMAT_2018_criteria-manual_2018-08-01_ENG.pdf. Accessed on: 04 November 2022.
  13. Joanna Briggs Institute. JBI Critical Appraisal Checklist for Case Reports. 2020. Available at: https://jbi.global/critical-appraisal-tools. Accessed on: 26 February 2023.
  14. Slade SC, Dionne CE, Underwood M, et al. Consensus on exercise reporting template (CERT): Explanation and elaboration statement. Br J Sports Med 2016;50(23):1428–1437. DOI: 10.1136/bjsports-2016-096651.
  15. Campbell M, McKenzie JE, Sowden A, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: Reporting guideline. BMJ 2020;368:l6890. DOI: 10.1136/bmj.l6890.
  16. Barker K. The effects of leg lengthening surgery on muscle function: Implications for rehabilitation. 2001. Available at: https://radar.brookes.ac.uk/radar/file/41150901-ccce-4267-ab40-29837ce7a458/1/barker2001effect.pdf. Accessed on: 21 May 2023.
  17. Stinner DJ. Optimization of outcomes following limb salvage of combat-related lower extremity trauma. 2019. Available at: http://wrap.warwick.ac.uk/151116. Accessed on: 21 May 2023.
  18. Open versus closed kinetic chain exercises in tibial distraction osteogenesis by Ilizarov's METHOD. 2018. Available at: https://beta.clinicaltrials.gov/study/NCT01738113. Accessed on: 21 May 2023.
  19. Coglianese DB, Herzenberg JE, Goulet JA. Physical therapy management of patients undergoing limb lengthening by distraction osteogenesis. J Orthop Sports Phys Ther 1993;17(3):124–132. DOI: 10.2519/jospt.1993.17.3.124.
  20. Taricco LD, Aoki SS. Rehabilitation of an adult patient with arthrogryposis multiplex congenita treated with an external fixator. Am J Phys Med Rehabil 2009;88(5):431–434. DOI: 10.1097/PHM.0b013e3181a0e249.
  21. Białoszewski D, Woźniak W, Zarek S. Clinical efficacy of kinesiology taping in reducing edema of the lower limbs in patients treated with the Ilizarov method—preliminary report. Ortop Traumatol Rehabil 2009;11(1):46–54. PMID: 19240683.
  22. Hing CB, Tutton E, Smith TO, et al. Reamed intramedullary nailing versus circular frame external fixation for segmental tibial fractures (STIFF-F): A mixed methods feasibility study. Pilot and Feasibility Studies 2021;7(1):93. DOI: 10.1186/s40814-021-00821-3.
  23. Gan YM. Physiotherapy in Ilizarov Fixation. Physiotherapy Singapore 2003;6(2):44–50.
  24. Simard S, Marchant M, Mencio G. The Ilizarov procedure: Limb lengthening and its implications. Phys Ther 1992;72(1):25–34. DOI: 10.1093/ptj/72.1.25.
  25. Green SA. Physiotherapy during Ilizarov fixation. Tech Orthop 1990;5(4):61–65. Available from: https://journals.lww.com/techortho/abstract/1990/12000/physiotherapy_during_ilizarov_fixation.10.aspx.
  26. Ahmed AA. Management of open complex tibial plateau fractures by Ilizarov fixator: Average follow-up of 8.5 years. Egyptian Orthop J 2019;54(1):72–78. DOI: 10.4103/eoj.eoj_5_19.
  27. Owens JG, Blair JA, Patzkowski JC, et al. Return to running and sports participation after limb salvage. J Trauma 2011;71(Suppl. 1):S120–S127. DOI: 10.1097/TA.0b013e3182219225.
  28. Blair JA, Patzkowski JC, Blanck RV, et al. Return to duty after integrated orthotic and rehabilitation initiative. J Orthop Trauma 2014;28(4):e70–e74. DOI: 10.1097/BOT.0000000000000006.
  29. Barker KL, Burns M, Littler S. Physiotherapy for patients with an Ilizarov external fixator: A survey of current practice. Physiotherapy 1999;85(8):426–432. DOI: 10.1016/S0031-9406(05)65501-0.
  30. de Ruijter MA, Lucke JA, Yuan JZ, et al. Patient experience from a doctor's perspective: A case report concerning treatment, fracture healing and rehabilitation of multiple complex injuries due to a high energy motor vehicle collision. Trauma Case Rep 2022;42:100699. DOI: 10.1016/j.tcr.2022.100699.
  31. Daf A, Gachake AA, Satone PR, et al. Early-stage physical therapy for a patient with proximal tibial fracture with acute compartment syndrome and neurovascular deficits managed with external fixation complicated by chronic osteomyelitis: A case report. Cureus 2022;14(11):e31333. DOI: 10.7759/cureus.31333.
  32. Shahade PS, Mundada PH, Zade RJ, et al. A novel implementation of physiotherapy in a known case of malunited supracondylar fracture of the femur with osteomyelitis managed with ilizarov fixator. Cureus;14(10):e30853. DOI: 10.7759/cureus.31333.
  33. Blair JA, Owens JG, Saucedo J, et al. Functional rehabilitation with a foot plate modification for circular external fixation. Foot Ankle Int 2013;34(6):890–897.
  34. Stannard JP, Sheils TM, McGwin G, et al. Use of a hinged external knee fixator after surgery for knee dislocation. Arthroscopy 2003;19(6): 626–631. DOI: 10.1016/s0749-8063(03)00125-7.
  35. American College of Sports Medicine. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc 2009;41(3):687–708. DOI: 10.1249/MSS.0b013e3181915670.
  36. Iliopoulos E, Galanis N. Physiotherapy after tibial plateau fracture fixation: A systematic review of the literature. SAGE Open Medicine 2020;8:2050312120965316. DOI: 10.1177/2050312120965316.
  37. Sharma H, Ferreira N, Mcdaid C, McNally M. International pin site consensus: Time to develop common grounds and collaborate? J Limb Lengthening Reconstr 2022;8(3):S1–S2. DOI: 10.4103/jllr.jllr_30_22.
  38. Murad MH, Asi N, Alsawas M, et al. New evidence pyramid. Evid Based Med 2016;21(4):125–127. DOI: 10.1136/ebmed-2016-110401.
  39. Claireaux HA, Beaumont O, Griffin XL, et al. Open lower limb fractures in the UK trauma system: A multicentre prospective audit of current practice. Injury 2021;52(6):1374–1383. DOI: 10.1016/j.injury.2020.12.038.
  40. Skivington K, Matthews L, Simpson SA, et al. A new framework for developing and evaluating complex interventions: Update of Medical Research Council guidance. BMJ 2021;374:n2061. DOI: 10.1136/bmj.n2061.
  41. Health and Care Professions Council (HCPC) Diversity Data Report 2021: Physiotherapists HCPC Diversity Data Report 2021. 2021. Available at: https://www.hcpc-uk.org/resources/reports/2021/diversity-data-report-2021/. Accessed on: 22 March 2023.
  42. Auliffe SM, Korakakis V, Hilfiker R, et al. Participant characteristics are poorly reported in exercise trials in tendinopathy: A systematic review. Phys Ther Sport 2021;48:43–53. DOI: 10.1016/j.ptsp.2020.12.012.
  43. Bafor A, Duncan ME, Iobst CA. Early Weight-bearing accelerates regenerate bone mineralisation: A pilot study comparing two post-operative weight-bearing protocols following intramedullary limb lengthening using the pixel value ratio. Strategies Trauma Limb Reconstr 2022;17(3):148–152. DOI: 10.5005/jp-journals-10080-1572.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.