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Interventions for improving outcomes after cast removal in tibia, fibula fractures

Tristan Manalac
22 Feb 2017

Joint mobilization, ultrasound therapy and therapeutic exercises may improve the range of motion of the ankle and decrease pain in patients with tibia and fibula fractures after cast removal, reports a study presented at the 7th Association of South-East Asian Pain Societies Congress (ASEAPS 2017).

The study included 26 patients (12 females, 14 males) who had fibula and tibia fractures. Those with open fractures, segmental fractures, osteomyelitis pathological fractures, and fractures with vessel, nerve or tendon injuries were excluded. Those with issues walking normally prior to the fracture were also excluded.

All participants received continuous mode ultrasound therapy at 1 MHz for 7 minutes, given 5 days per week for 4 weeks. They also underwent joint mobilization via glide technique for 10 minutes.

Ankle joint range of motion, the 6-minute walk test and the visual analogue scale (VAS) pain score were used to evaluate the effect of the combination of treatments on the postfracture stiffness of fibula and tibia fractures.

Analysis found that most injuries occurred in patients between the ages of 31 and 40 years (mean age 38.08±11.903 years) and were caused by traffic accidents and falls. The most common site of injury was the distal third of tibia and fibula (12 to 46.2 percent), with the duration of immobilization being 17.35 weeks (range, 16 to 22 weeks).  [ASEAPS Congress 2017, abstract 0093]

VAS pain score improved significantly from 0.46 at pretreatment to 0 (no pain) at a follow-up of 2 weeks after completing treatment. Ankle dorsiflexion range of motion increased significantly from 6.81±2.417° at pretreatment to 17.85±2.167° at treatment conclusion, while ankle planter flexion range of motion similarly increased from 22±4.974° to 45.81±3.476°.

The 6-minute walk distance also improved significantly from 363.5 meters at baseline to 440±40.891 meters at the end of post-treatment follow-up (p<0.001).

The findings thus show that the combination of therapeutic exercises, joint mobilization and ultrasound therapy improves range of motion, pain and functional outcomes after cast removal in patients with tibia and fibula fractures.

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