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Optimising mobility outcomes after severe ankle injury in adultsKeene, David J. January 2014 (has links)
Severe ankle injuries can result in ligament rupture or a fracture. A major problem after such injuries is limitation in mobility. Weight bearing tasks, such as walking, become a problem because of pain, deficits in joint range of motion and muscle strength. This thesis studies a key dilemma in early rehabilitation, whether to immobilise the ankle or allow joint motion to improve mobility outcomes. Studies have focused on two scenarios, severe ligament rupture, and unstable fractures managed through open reduction and internal fixation (ORIF). The analysis of gait outcomes was an important component of this thesis and a novel analytical method was developed to normalise gait velocity in the estimation of speed-dependent gait outcomes. A systematic review and meta-analysis was conducted including evidence to July 2014. The reporting and design of trials was universally poor. In the 6 weeks of recovery following ankle ORIF surgery, there was insufficient evidence that early ankle movements offered a benefit to mobility recovery compared with immobilisation in a cast. Ankle movements compared with immobilisation reduced the risk of venous thrombosis/thromboembolism. However, compared with cast immobilisation, the risk of deep and superficial surgical site infection and fixation-related complications were higher when ankle movements were permitted. To investigate the role of ankle supports in rehabilitation of walking after ORIF, two randomised cross-over studies were completed. In healthy participants with non-pathological gait, a walker boot induced gait abnormalities when compared with Tubigrip (elasticated bandage). There were no important differences in gait between a stirrup brace and Tubigrip. In people who had undergone ankle ORIF 6 weeks previously, a walker boot and to a lesser extent a stirrup brace offered improvements in gait symmetry and lower pain scores when compared with Tubigrip. Finally, a secondary analysis of the Collaborative Ankle Support Trial cohort (n=584) was conducted, which concluded that, in comparison to Tubigrip, 10 days of cast immobilisation provided greater probability of recovery of a range of mobility outcomes 4 weeks following injury. This thesis contributes evidence favouring a role for ankle immobilisation in improving mobility following severe ankle injury in adults. Clinicians should be aware of the benefits and risk of harms outlined, as well as the limitations in the current evidence base.
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Anti-gravity treadmill rehabilitation improves gait and muscle atrophy in patients with surgically treated ankle and tibial plateau fractures after one year: A randomised clinical trialPalke, Lisa, Schneider, Sebastian, Karich, Bernhard, Mende, Meinhard, Josten, Christoph, Böhme, Jörg, Henkelmann, Ralf 27 April 2023 (has links)
To compare the one-year postoperative outcomes of anti-gravity treadmill rehabilitation with those of standard rehabilitation in patients with ankle or tibial plateau fractures.
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Relação do polimorfismo do receptor P2X7 com a densidade mineral óssea: estudo em pacientes idosos com fraturas do tornozelo / Relationship between polymorphism of receptor P2X7 with bone mineral density: a study on elderly patients with ankle fracturesKelly Cristina Stefani 05 December 2018 (has links)
O objetivo deste estudo foi determinar se a variação genética no gene do receptor P2X7 está associada com a diminuição da densidade mineral óssea e o risco de osteoporose em pacientes acima de 50 anos de idade com fratura de tornozelo. Foi realizado um estudo diagnóstico Nível I. Os pacientes acima de 50 anos com fratura de tornozelo submetidos ao tratamento cirúrgico foram divididos em dois grupos após o resultado da densitometria óssea: o grupo de estudo com osteopenia (T score entre -1 e -2,5) ou osteoporose (T score <= -2,5) e o grupo controle com valores de normalidade (com T score >= -1). Os critérios de exclusão foram alterações que levam à osteoporose secundária. Os pacientes foram genotipados para 15 polimorfismos de nucleotídeo único (SNPs) não sinônimos dentro do receptor P2X7 (numerados de 1 à 15) obtidos a partir da saliva. Avaliamos 121 pacientes com fratura de tornozelo, sendo 56 do grupo controle e 65 do grupo de estudo. Todos os pacientes eram sedentários, não utilizavam nenhum medicamento para tratamento de osteoporose, não eram tabagistas e sofreram trauma de baixa energia. A análise agrupada das alterações dos SNPs demonstrou que se o gene tem 3 ou mais variantes de SNPs (36,4% dos 121 pacientes), dos 15 possíveis, ele está alterado com repercussão clínica relacionada à perda ou ganho de função do gene. E ao analisar as alterações dos SNPs, individualmente, os resultados sugerem que: os SNPs 1,4,14 e 15 são variantes de perda de função; SNPs 5 e 10 são descritos como variantes de perda de função; entretanto, não têm influência na nossa população; SNPs 11 e 13 são variantes de perda de função e não ganho de função, como descrito na literatura; e SNP 12 foi associado à perda de função em nossa população. Podemos ressaltar como limitações do nosso estudo o fato de nos concentramos principalmente em polimorfismos não sinônimos que não cobrem toda a variação genética em P2X7 e no número pequeno de participantes quando comparados com a literatura mundial. Em contrapartida, um dos pontos fortes do nosso estudo é ser o primeiro a avaliar o P2X7 na população brasileira, que é bastante heterogênea do ponto de vista genético devido à nossa miscigenação, quando comparado com os outros estudos que avaliaram a população do norte da Europa, que é mais homogênea geneticamente. Em conclusão, o polimorfismo do SNP 12 em P2X7 está associado à densidade mineral óssea e risco de fraturas de tornozelo / The purpose of this study was to determine whether a genetic variation in the P2X7 receptor gene is associated with reduced bone mineral density and the risk of osteoporosis in patients over 50 years of age with ankle fractures. A Level-1 diagnostic study was conducted. Patients over 50 years of age with ankle fractures who had undergone surgical treatment were divided into two groups following the result of a bone densitometry: a study group with osteopenia (bone mineral density T score between -1 and -2.5) or osteoporosis (bone mineral density T score <= -2.5) and the control group with normal values (bone mineral density T score >= -1). Exclusion criteria were alterations that led to secondary osteoporosis. Patients were genotyped for 15 nonsynonymous single nucleotide polymorphisms (SNPs) within the P2X7 receptor (numbered from 1 to 15) obtained from saliva. We evaluated 121 patients with ankle fractures, 56 being from the control group, and 65 from the study group. All patients were sedentary, did not take any medication for the treatment of osteoporosis, did not smoke, and had suffered a low-impact trauma. The grouped assessment of the SNP alterations showed that if a gene has three or more SNP variants (36.4% of the 121 patients), out of the 15 possibilities, it is altered with clinical repercussions related to the loss or gain of the function of the gene. In evaluating the SNP alterations individually, the results suggest that: SNPs 1,4,14, and 15 are loss of function variants; SNPs 5 and 10 are described as loss of function variants; however, they have no influence on our study population; SNPs 11 and 13 are loss of function variants and not gain of function function as is described in the literature; and SNP 12 was associated with a loss of function in our population. In conclusion, we showed that the functional polymorphisms in P2X7 are associated with Bone Mineral Density and the risk of ankle fractures. As limitations to our study, we can point out the fact that we focused mainly on nonsynonymous polymorphisms, which do not cover all the genetic variations in P2X7, and the small number of participants when compared to the world literature. On the other hand, a strength of our study is that it was the first to assess P2X7 in the Brazilian population, which is quite heterogeneous from the genetic point of view due to our miscegenation, as compared to other studies that evaluated the population of northern Europe, which is genetically more homogeneous. In conclusion, the SNP12 polymorphism in P2X7 is associated with Bone Mineral Density and the risk of ankle fractures
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Relação do polimorfismo do receptor P2X7 com a densidade mineral óssea: estudo em pacientes idosos com fraturas do tornozelo / Relationship between polymorphism of receptor P2X7 with bone mineral density: a study on elderly patients with ankle fracturesStefani, Kelly Cristina 05 December 2018 (has links)
O objetivo deste estudo foi determinar se a variação genética no gene do receptor P2X7 está associada com a diminuição da densidade mineral óssea e o risco de osteoporose em pacientes acima de 50 anos de idade com fratura de tornozelo. Foi realizado um estudo diagnóstico Nível I. Os pacientes acima de 50 anos com fratura de tornozelo submetidos ao tratamento cirúrgico foram divididos em dois grupos após o resultado da densitometria óssea: o grupo de estudo com osteopenia (T score entre -1 e -2,5) ou osteoporose (T score <= -2,5) e o grupo controle com valores de normalidade (com T score >= -1). Os critérios de exclusão foram alterações que levam à osteoporose secundária. Os pacientes foram genotipados para 15 polimorfismos de nucleotídeo único (SNPs) não sinônimos dentro do receptor P2X7 (numerados de 1 à 15) obtidos a partir da saliva. Avaliamos 121 pacientes com fratura de tornozelo, sendo 56 do grupo controle e 65 do grupo de estudo. Todos os pacientes eram sedentários, não utilizavam nenhum medicamento para tratamento de osteoporose, não eram tabagistas e sofreram trauma de baixa energia. A análise agrupada das alterações dos SNPs demonstrou que se o gene tem 3 ou mais variantes de SNPs (36,4% dos 121 pacientes), dos 15 possíveis, ele está alterado com repercussão clínica relacionada à perda ou ganho de função do gene. E ao analisar as alterações dos SNPs, individualmente, os resultados sugerem que: os SNPs 1,4,14 e 15 são variantes de perda de função; SNPs 5 e 10 são descritos como variantes de perda de função; entretanto, não têm influência na nossa população; SNPs 11 e 13 são variantes de perda de função e não ganho de função, como descrito na literatura; e SNP 12 foi associado à perda de função em nossa população. Podemos ressaltar como limitações do nosso estudo o fato de nos concentramos principalmente em polimorfismos não sinônimos que não cobrem toda a variação genética em P2X7 e no número pequeno de participantes quando comparados com a literatura mundial. Em contrapartida, um dos pontos fortes do nosso estudo é ser o primeiro a avaliar o P2X7 na população brasileira, que é bastante heterogênea do ponto de vista genético devido à nossa miscigenação, quando comparado com os outros estudos que avaliaram a população do norte da Europa, que é mais homogênea geneticamente. Em conclusão, o polimorfismo do SNP 12 em P2X7 está associado à densidade mineral óssea e risco de fraturas de tornozelo / The purpose of this study was to determine whether a genetic variation in the P2X7 receptor gene is associated with reduced bone mineral density and the risk of osteoporosis in patients over 50 years of age with ankle fractures. A Level-1 diagnostic study was conducted. Patients over 50 years of age with ankle fractures who had undergone surgical treatment were divided into two groups following the result of a bone densitometry: a study group with osteopenia (bone mineral density T score between -1 and -2.5) or osteoporosis (bone mineral density T score <= -2.5) and the control group with normal values (bone mineral density T score >= -1). Exclusion criteria were alterations that led to secondary osteoporosis. Patients were genotyped for 15 nonsynonymous single nucleotide polymorphisms (SNPs) within the P2X7 receptor (numbered from 1 to 15) obtained from saliva. We evaluated 121 patients with ankle fractures, 56 being from the control group, and 65 from the study group. All patients were sedentary, did not take any medication for the treatment of osteoporosis, did not smoke, and had suffered a low-impact trauma. The grouped assessment of the SNP alterations showed that if a gene has three or more SNP variants (36.4% of the 121 patients), out of the 15 possibilities, it is altered with clinical repercussions related to the loss or gain of the function of the gene. In evaluating the SNP alterations individually, the results suggest that: SNPs 1,4,14, and 15 are loss of function variants; SNPs 5 and 10 are described as loss of function variants; however, they have no influence on our study population; SNPs 11 and 13 are loss of function variants and not gain of function function as is described in the literature; and SNP 12 was associated with a loss of function in our population. In conclusion, we showed that the functional polymorphisms in P2X7 are associated with Bone Mineral Density and the risk of ankle fractures. As limitations to our study, we can point out the fact that we focused mainly on nonsynonymous polymorphisms, which do not cover all the genetic variations in P2X7, and the small number of participants when compared to the world literature. On the other hand, a strength of our study is that it was the first to assess P2X7 in the Brazilian population, which is quite heterogeneous from the genetic point of view due to our miscegenation, as compared to other studies that evaluated the population of northern Europe, which is genetically more homogeneous. In conclusion, the SNP12 polymorphism in P2X7 is associated with Bone Mineral Density and the risk of ankle fractures
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