Distal radius fractures: What are the effects of ulnar styloid fracture and face-toface rehabilitation on the functional outcome?

OBJECTIVE: This study aimed to investigate the effects of the accompanying ulnar styloid fracture and 2 different postoperative rehabilitation protocols on the final outcomes following surgical treatment of distal radius fractures. METHODS: In this retrospective study, 47 patients (11 male, 35 female; mean age=52.6 years, age range=24-85) who underwent plate fixation for distal radius fractures were divided into 4 groups based on the presence of an ulnar styloid fracture and type of rehabilitation. To evaluate clinical outcomes, wrist range of motion (ROM), grip strength, lateral pinch strength, disabilities of the arm, shoulder, and hand (DASH) questionnaire scores and visual analog scale (VAS) scores were obtained at the final follow-up. The rehabilitation exercises of the patients in groups 1 and 2 were carried out in the physical therapy room by the hand therapist during the postoperative 2 months. Patients in groups 3 and 4 were supplied with videos of the exercises of each phase and instructed to carry out those exercises at home routinely. RESULTS: Patients who received home rehabilitation programs demonstrated greater grip strength loss. Patients without accompanying ulnar styloid fractures had better DASH and VAS scores. Final wrist ROM and the duration for return to preinjury activity level did not differ among groups. CONCLUSION: This study has suggested that accompanying ulnar styloid fractures may worsen the functional outcomes after plate fixation of distal radius fractures. Home-based programs may provide patients with adequate overall wrist function with certain drawbacks compared to rehabilitation under direct supervision.

Rehabilitation of Patients With Osteoporotic Fractures.

Osteoporosis is a silent, asymptomatic disease until a fragility fracture is sustained. Fractures greatly affect the physical functioning and health-related quality of life and are associated with increased mortality and morbidity rates. Furthermore, once a fragility fracture occurs, the patient is more susceptible to sustain further fractures. Repeated falls are the main causes of fractures in patients with osteoporosis. The management of osteoporosis postfracture is a combination of medical treatment, nutritional interventions, and rehabilitation in order to improve activities of daily living to prevent falls and increase safety while reducing the loss of bone mass. In this article the principles of fracture prevention and physical rehabilitation of patients with osteoporosis postvertebral and hip fragility fractures will be discussed, as well as the rehabilitation management to prevent further falls and fractures.

A Rehabilitation Protocol for Patients with Lumbar Degenerative Disc Disease Treated with Posterior Transpedicular Dynamic Stabilization.

AIM: To evaluate the efficacy of the rehabilitation protocol on patients with lumbar degenerative disc disease after posterior transpedicular dynamic stabilization (PTDS) surgery. MATERIAL AND METHODS: Patients (n=50) with single level lumbar degenerative disc disease were recruited for this study. Patients had PTDS surgery with hinged screws. A rehabilitation program was applied for all patients. Phase 1 was the preoperative evaluation phase. Phase 2 (active rest phase) was the first 6 weeks after surgery. During phase 3 (minimal movement phase, 6-12 weeks) pelvic tilt exercises initiated. In phase 4 (dynamic phase, 3-6 months) dynamic lumbar stabilization exercises were started. Phase 5 (return to sports phase) began after the 6th month. The primary outcome criteria were the Visual Analogue Pain Score (VAS) and the Oswestry Disability Index (ODI). Patients were evaluated preoperatively, postoperative 3rd, 12th and 24th months. RESULTS: The mean preoperative VAS and ODI scores were 7.52±0.97 and 60.96±8.74, respectively. During the 3rd month, VAS and ODI scores decreased to 2.62±1.05 and 26.2±7.93, respectively. VAS and ODI scores continued to decrease during the 12th month after surgery to 1.4±0.81 and 13.72±6.68, respectively. At the last follow-up (mean 34.1 months) the VAS and ODI scores were found to be 0.68±0.62 and 7.88±3.32, respectively. (p=0.0001). CONCLUSION: The protocol was designed for a postoperative rehabilitation program after PTDS surgery for patients with lumbar degenerative disc disease. The good outcomes are the result of a combination of very careful and restrictive patient selection, surgical technique, and the presented rehabilitation program.

Effect of Posterior Dynamic Instrumentation on High-Intensity Zone in Lumbar Degenerative Disc Disease.

AIM: To investigate high-intensity zone (HIZ) changes after lumbar posterior dynamic instrumentation. MATERIAL AND METHODS: Our study included 53 patients: 27 patients in group 1, 26 patients in group 2. All patients had one or two levels of degenerative disc disease with an HIZ confirmed by magnetic resonance imaging (MRI). Group 1 underwent one- or two-level dynamic lumbar posterior instrumentation. Group 2 was treated conservatively with an exercise program. Patients were evaluated using MRI, a numerical visual analog pain scale (VAS), and the Oswestry Disability Index (ODI) at baseline, at 1 year after surgery, and at final follow-up evaluation. RESULTS: The mean duration of follow-up was 49.3 months in group 1 and 47.19 months in group 2. The baseline VAS and ODI scores were similar for both groups. The mean VAS score of group 1 was significantly improved at 1 year after surgery and at final follow-up. The mean ODI value was lower in group 1 than in group 2 at 1 year and at final follow-up. Pfirrmann grades in group 1 significantly differed at 1 year and at final follow-up but did not change in group 2. The number of HIZs significantly decreased in from baseline to 1 year and from baseline to final follow-up in group 1 but did not differ in group 2. CONCLUSION: Dynamic lumbar stabilization systems are promising. Observations such as Pfirrmann grade improvements and disappearance of HIZs are concordant with improvements in VAS and ODI scores demonstrate that dynamic stabilization systems may provide an environment for regeneration.

Dynamic stabilisation in the treatment of degenerative disc disease with modic changes.

Objective. Posterior dynamic stabilization is an effective alternative to fusion in the treatment of chronic instability and degenerative disc disease (DDD) of the lumbar spine. This study was undertaken to investigate the efficacy of dynamic stabilization in chronic degenerative disc disease with Modic types 1 and 2. Modic types 1 and 2 degeneration can be painful. Classic approach in such cases is spine fusion. We operated 88 DDD patients with Modic types 1 and 2 via posterior dynamic stabilization. Good results were obtained after 2 years of followup. Methods. A total of 88 DDD patients with Modic types 1 and 2 were selected for this study. The patients were included in the study between 2004 and 2010. All of them were examined with lumbar anteroposterior (AP) and lateral X-rays. Lordosis of the lumbar spine, segmental lordosis, and ratio of the height of the intervertebral disc spaces (IVSs) were measured preoperatively and at 3, 12, and 24 months after surgery. Magnetic resonance imaging (MRI) analysis was carried out, and according to the data obtained, the grade of disc degeneration was classified. The quality of life and pain scores were evaluated by visual analog scale (VAS) score and Oswestry Disability Index (ODI) preoperatively and at 3, 12, and 24 months after surgery. Appropriate statistical method was chosen. Results. The mean 3- and 12-month postoperative IVS ratio was significantly greater than that of the preoperative group (P < 0.001). However, the mean 1 and 2 postoperative IVS ratio was not significantly different (P > 0.05). Furthermore, the mean preoperative and 1 and 2 postoperative angles of lumbar lordosis and segmental lordosis were not significantly different (P > 0.05). The mean VAS score and ODI, 3, 12, and 24 months after surgery, decreased significantly, when compared with the preoperative scores in the groups (P = 0.000). Conclusion. Dynamic stabilization in chronic degenerative disc disease with Modic types 1 and 2 was effective.

Posterior Transpedicular Dynamic Stabilization versus Total Disc Replacement in the Treatment of Lumbar Painful Degenerative Disc Disease: A Comparison of Clinical Results.

Study Design. Prospective clinical study. Objective. This study compares the clinical results of anterior lumbar total disc replacement and posterior transpedicular dynamic stabilization in the treatment of degenerative disc disease. Summary and Background Data. Over the last two decades, both techniques have emerged as alternative treatment options to fusion surgery. Methods. This study was conducted between 2004 and 2010 with a total of 50 patients (25 in each group). The mean age of the patients in total disc prosthesis group was 37,32 years. The mean age of the patients in posterior dynamic transpedicular stabilization was 43,08. Clinical (VAS and Oswestry) and radiological evaluations (lumbar lordosis and segmental lordosis angles) of the patients were carried out prior to the operation and 3, 12, and 24 months after the operation. We compared the average duration of surgery, blood loss during the surgery and the length of hospital stay of both groups. Results. Both techniques offered significant improvements in clinical parameters. There was no significant change in radiologic evaluations after the surgery for both techniques. Conclusion. Both dynamic systems provided spine stability. However, the posterior dynamic system had a slight advantage over anterior disc prosthesis because of its convenient application and fewer possible complications.

Skipping posterior dynamic transpedicular stabilization for distant segment degenerative disease.

Objective. To date, there is still no consensus on the treatment of spinal degenerative disease. Current surgical techniques to manage painful spinal disorders are imperfect. In this paper, we aimed to evaluate the prospective results of posterior transpedicular dynamic stabilization, a novel surgical approach that skips the segments that do not produce pain. This technique has been proven biomechanically and radiologically in spinal degenerative diseases. Methods. A prospective study of 18 patients averaging 54.94 years of age with distant spinal segment degenerative disease. Indications consisted of degenerative disc disease (57%), herniated nucleus pulposus (50%), spinal stenosis (14.28%), degenerative spondylolisthesis (14.28%), and foraminal stenosis (7.1%). The Oswestry Low-Back Pain Disability Questionnaire and visual analog scale (VAS) for pain were recorded preoperatively and at the third and twelfth postoperative months. Results. Both the Oswestry and VAS scores showed significant improvement postoperatively (P < 0.05). We observed complications in one patient who had spinal epidural hematoma. Conclusion. We recommend skipping posterior transpedicular dynamic stabilization for surgical treatment of distant segment spinal degenerative disease.

Rehabilitation protocol after suspension arthroplasty of thumb carpometacarpal joint osteoarthritis.

STUDY DESIGN: Retrospective case series. INTRODUCTION: When conservative modalities and therapies fail to control symptoms of thumb carpometacarpal (CMC) joint osteoarthritis, surgery may be indicated. PURPOSE OF THE STUDY: To present a rehabilitation protocol used in a series of patient cases after suspension arthroplasty and to evaluate outcomes. METHODS: Twenty-seven patients with CMC osteoarthritis were treated by the same arthroplasty technique and the same rehabilitation program. Patients were evaluated before and 12th week after surgery, and at the last follow-up using a visual analog scale; the Disability of the Arm, Shoulder, and Hand questionnaire; strength measurements; range of motion evaluations; and radiographic assessment. RESULTS: Average follow-up period was 31.5 months. There was a decreasing trend in both subjective scores during follow-ups (p=0.0001). Thirty-three percent and 30% improvements on radial and palmar abductions, respectively, and 29% improvement on pinch strengths were recorded at the final follow-up. Postoperative grip improvement was not preserved at the last follow-up. CONCLUSIONS: The results demonstrate a high degree of patient satisfaction suggesting the efficacy of this surgical technique and postoperative rehabilitation protocol. LEVEL OF EVIDENCE: Level 4.

A rehabilitation protocol for patients with lumbar degenerative disk disease treated with lumbar total disk replacement.

OBJECTIVES: To evaluate the efficacy of the rehabilitation protocol designed by the Physical Medicine and Rehabilitation Department on the patients with lumbar degenerative disk disease after lumbar disk replacement surgery. DESIGN: Open prospective auto-controlled trial. SETTING: Physical medicine and rehabilitation department, neurosurgery department, and anesthesiology and pain management department. PARTICIPANTS: Patients (N=20) with single level lumbar degenerative disk disease were recruited for this study. INTERVENTIONS: Lumbar disk prosthesis surgery with metal on metal lumbar disk prosthesis; preoperative, provocative, diskography; and a postoperative rehabilitation program were used. MAIN OUTCOME MEASURES: Change in the functional status and pain intensity in patients was evaluated by the Oswestry Disability Index (ODI) and visual analog scale (VAS) during rest and movement. The ODI and VAS during rest and movement were primary outcome criteria, while return to work and duration of hospital stay were secondary outcome criteria. The results for the various scoring systems were statistically analyzed using the t test. RESULTS: Preoperative mean VAS scores ± SD at rest and movement were initially in the range of 6.00±2.47 and 8.65±1.08, respectively. The scores decreased to 1.70±1.12 and 2.60±1.72 at 3 months postsurgery, respectively (P<0.01). The scores decreased to 1.20±0.69 and 1.90±1.07 at 12 months postsurgery, respectively (P<0.01). The mean preoperative ODI score was 73.3±15.5; the postoperative scores were 35.0±15.5 and 20.4±12.9 at 3 and 12 months, respectively (P<0.01). The mean duration of hospital stay ± SD was 3.5±1.6 days, and return to work was achieved after a mean ± SD period of 14.1± 4.3 days with no complications related to surgery or the rehabilitation protocol. CONCLUSIONS: The protocol was designed for postoperative rehabilitation program after artificial lumbar disk replacement surgery for degenerative disk disease patients. The good outcomes are the result of a combination of very careful and restrictive patient selection, surgical technique, and presented rehabilitation program. These parameters provide early pain relief and return to activities of daily living after surgery.

The combined use of a posterior dynamic transpedicular stabilization system and a prosthetic disc nucleus device in treating lumbar degenerative disc disease with disc herniations.

BACKGROUND: Prosthetic replacement of spinal discs is emerging as a treatment option for degenerative disc disease. Posterior dynamic transpedicular stabilization (PDTS) and prosthetic disc nucleus (PDN) devices have been used sporadically in spinal surgery. METHODS: This was a prospective study of 13 patients averaging 40.9 years of age with degenerative disc disease who underwent posterior placement of a PDN with a PDTS. The Oswestry low-back pain disability questionnaire and visual analog scale (VAS) for pain were used to assess patient outcomes at the 3rd, 6th, and 12th postoperative months. Lumbar range of motion was evaluated using a bubble inclinometer preoperatively and at 12 months postoperatively. Radiological parameters including lumbar lordosis angle (LL), segmental lordosis angle (α), disc height at the operated level (DHo), and disc height of the adjacent level (DHu) were evaluated. A typical midline posterior approach for complete discectomy was followed by the simultaneous placement of the PDN with PDTS. RESULTS: Both the Oswestry and VAS scores showed significant improvement postoperatively (P < .05). There were no significant differences in LL, α, DHo, and DHu parameters. We observed complications in 3 patients including 2 patients who had the PDN device embedded into the adjacent corpus; 1 had massive endplate degeneration, and the other experienced interbody space infection. In 1 patient, the PDN device migrated to one side in the vertebral space. CONCLUSION: The use of a PDN in combination with posterior dynamic instrumentation can help to restore the physiologic motion of the anterior and posterior column and could help to establish posterior dynamic instrumentation as an important treatment of degenerative disc disease. Theoretically this concept is superior, but practically we need more advanced technology to replace disc material. Because this study examined the combination of the PDN and stabilization instrumention, the results cannot be compared with those reported in the literature for either PDN alone or dynamic screws alone. LEVEL OF EVIDENCE: Prospective cohort study with good follow-up (level 1b).