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Radiological study of the secondary reduction effect of early functional exercise on displaced intra-articular calcaneal fractures after internal compression fixation

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Abstract

Purpose

Early post-operative exercise and weight-bearing activities are found to improve the functional recovery of patients with displaced intra-articular calcaneal fractures (DIACFs). We hypothesized that early functional exercise after surgery might have a secondary reduction effect on the subtalar joint, in particular the smaller fracture fragments that were not fixed firmly. A prospective study was conducted to verify this hypothesis.

Methods

From December 2012 to September 2013, patients with unilateral 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 weight bearing starting week three, and full weight bearing starting week 12. Patients in the control group followed a conventional post-operative protocol of partial weight bearing after week six and full weight bearing after the bone healed. Computed tomography (CT) scanning was performed at post-operative 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. Function was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring scale at the 12th post-operative month.

Results

Twenty-eight patients in the study group and 32 in the control group were followed up for more than 12 months; their data were collected and used for the final analysis. Repeated-measures analysis of variance (ANOVA) of the maximal residual displacements of the fracture measured on CT images revealed significant differences between the study and the control groups. There were interaction effects between group and time point. Except for the first time point, the differences between the groups at all studied time points were significant. In the study group, the differences between all studied time points were significant. Strong correlations were observed between the AOFAS score at post-operative month 12 and the maximal residual displacement of the fractures on the CT images at postoperative week 12.

Conclusions

Early functional exercise and weight bearing activity can smooth and shape the subtalar joint and reduce the residual displacement of the articular surface, improving functional recovery of the affected foot. Therefore, early rehabilitation functional exercise can be recommended in clinical practice.

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Abbreviations

DIACF:

displaced intra-articular calcaneal fracture

AOFAS:

American Orthopedic Foot and Ankle Society

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Acknowledgements

The authors wish to thank Dr. Zekun Zhang and Xiaona Li, roentgenologist, for their assistance in this study. This study was supported by the National Natural Science Foundation of China (Grant No. 81401789) and the Top Young Talents for Hebei Province (2013-2015). The funding sources have no role in study design, conduction, data collection, or statistical analysis.

Author information

Author notes

  1. Wei Chen, Bo Liu, Hongzhi Lv and Yanling Su contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, People’s Republic of China

    Wei Chen, Bo Liu, Hongzhi Lv, Yanling Su, Xiao Chen, Yanbin Zhu, Chenguang Du & Yingze Zhang

  2. Department of Epidemiology and Statistics, Hebei Medical University, Shijiazhuang, People’s Republic of China

    Xiaolin Zhang

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  1. Wei Chen
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Correspondence to Yingze Zhang.

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Conflict of interest statement

This study was supported by the National Natural Science Foundation of China (Grant No. 81401789) and the Top Young Talents for Hebei Province (2013–2015). The funding sources have no role in study design, conduction, data collection, or statistical analysis. On behalf of all authors, the corresponding author states that there is no other conflict of interest.

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Chen, W., Liu, B., Lv, H. et al. Radiological study of the secondary reduction effect of early functional exercise on displaced intra-articular calcaneal fractures after internal compression fixation. International Orthopaedics (SICOT) 41, 1953–1961 (2017). https://doi.org/10.1007/s00264-017-3533-z

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