Ekinci Mehmet, Birisik Fevzi, Ersin Mehmet, Şahinkaya Türker, Öztürk İrfan
Department of Orthopaedics and Traumatology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
Department of Orthopaedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey.
Turk J Phys Med Rehabil. 2021 Sep 1;67(3):300-307. doi: 10.5606/tftrd.2021.5427. eCollection 2021 Sep.
This study aims to evaluate patients with conservatively treated stable lateral malleolar fractures with isokinetic tests.
Between January 2016 and November 2017, a total of 24 patients (12 males, 12 females; mean age 40.8±15.0 years; range, 18 to 68 years) with an isolated stable lateral malleolar fracture treated conservatively with the circular cast were included in this prospective study. Calf circumferences, ankle range of motion (ROM), pain levels, and functional outcomes were recorded. The muscle strengths and endurance of the injured side were compared with the non-injured side. All patients were evaluated by isokinetic test after removal of the cast, and three and six months after the rehabilitation period.
The ROM was found to be lower after removal of the plaster cast, compared to the contralateral ankle. During cast removal, we also found that both dorsiflexor and plantar flexor muscle strength decreased by 25.6% and 44.7%, respectively, and decreased to 10.3% and 3.6% at three months post-rehabilitation. At the end of six months, no statistically significant difference was found between the two sides. In the dorsiflexion-plantar flexion endurance values, 37.8% and 54.1% deficit were detected before the rehabilitation protocol, respectively (p<0.05). At three months, these values decreased to 6.1% and 13.6%, respectively and the endurances of the injured sides surpassed the non-injured sides (p<0.05) at six months.
Conservative management of stable isolated lateral malleolar fractures with circular cast causes atrophy and decreases strength-endurance of the calf muscles due to immobilization. These changes are expected to diminish over time and functional outcomes are excellent with a good rehabilitation program.
本研究旨在通过等速测试评估保守治疗的稳定型外踝骨折患者。
2016年1月至2017年11月期间，本前瞻性研究纳入了24例（12例男性，12例女性；平均年龄40.8±15.0岁；范围18至68岁）单纯稳定型外踝骨折且采用环形石膏保守治疗的患者。记录小腿周长、踝关节活动范围（ROM）、疼痛程度和功能结果。将患侧的肌肉力量和耐力与未受伤侧进行比较。所有患者在拆除石膏后、康复期3个月和6个月后通过等速测试进行评估。
与对侧踝关节相比，拆除石膏后ROM较低。拆除石膏时，我们还发现背屈肌和跖屈肌力量分别下降了25.6%和44.7%，康复3个月时分别降至10.3%和3.6%。在6个月末，两侧之间未发现统计学上的显著差异。在背屈-跖屈耐力值方面，康复方案实施前分别检测到37.8%和54.1%的不足（p<0.05）。在3个月时，这些值分别降至6.1%和13.6%，患侧的耐力在6个月时超过了未受伤侧（p<0.05）。
采用环形石膏对稳定型单纯外踝骨折进行保守治疗会因固定导致小腿肌肉萎缩并降低力量耐力。随着时间推移，这些变化预计会减轻，并且通过良好的康复方案，功能结果极佳。
