Very early prescription of range of motion exercises in ankle fractures treated with ORIF does not increase the rate of complications and reoperations: A survival risk analysis.

BACKGROUND: Ankle fractures are commonly treated with non-surgical or surgical (preferably ORIF) approaches based on fracture characteristics. The postoperative care regimens vary widely, and the impact of very early mobilization on complications and reoperation rates in ankle fractures treated with ORIF remains unclear. METHODS: A retrospective analysis was conducted on ankle fractures treated between January 2014 and November 2020. Demographic and fracture characteristic data were collected. Very early prescription of range of motion exercises was defined as initiation within the first week after surgery, typically between the second and seventh postoperative day. Complications, reoperations, and time to these events were analyzed. Kaplan Meier survival analysis was performed to assess the risk of complications with very early mobilization. RESULTS: A total of 299 patients met the inclusion criteria. The cohort included 83 unimalleolar, 77 bimalleolar, and 138 trimalleolar fractures. Of the patients, 116 (38.8%) underwent very early range of motion. Complications occurred in 45 events among 39 patients (13%), with 16 events (41%) in the very early range of motion group. Reoperations were required for 23 patients (3.67% of the cohort). No statistically significant differences were found in the analysis of complications, with a hazard ratio (HR) of 1.17, and in the adjusted analysis with an HR of 1.12. Similarly, the reoperation analysis showed no significant differences, with an HR of 0.85 and 0.68 in the adjusted analysis. CONCLUSION: Very early prescription of range of motion exercises in ankle fractures treated with ORIF is a safe approach, as it does not increase the rates of complications or reoperations compared to early or late mobilization. This study supports the use of very early mobilization as a rehabilitation method for ankle fractures.

[Lower limb discrepancy after total knee arthroplasty. Is it really an issue?] / Discrepancia de miembros inferiores en artroplastia total de rodilla. ¿Es realmente un problema?

Introduction: Lower limb discrepancy after total knee arthroplasty (TKA) is common. The main objective of this study is to evaluate the incidence of lower limb discrepancy after TKA. Materials and methods: this is an observational analytical retrospective cohort study. We have included all the patients who underwent unilateral TKA with the same type of implant. The limb length was measured with a panoramic lower limb x-ray. The cut-off point to consider the discrepancy was > 10 mm. The type of deformity and the functional outcomes were evaluated. Results: In a total of 60 patients, 18 (30%) showed a lower limb discrepancy. Out of the patients who presented discrepancy, the most frequent deformity was valgus deformity with a 55,6% followed by varus deformity with 38.89% and 5.56% with neutral axis. The functional outcomes according to the KSS score and the postoperative knee KSS score demonstrated no difference in long term follow up between both groups. Conclusions: the incidence of lower limb discrepancy after TKA was 30%. None of the patients required surgery as a consequence of the discrepancy. The functional outcomes and pain in a long term follow up did not demonstrate differences between both groups.

Introducción: La discrepancia de longitud en miembros inferiores en pacientes con reemplazo total de rodilla (RTR) es una situación frecuente. El objetivo principal fue evaluar la incidencia de discrepancia de longitud en pacientes operados de RTR. Materiales y métodos: Estudio observacional, analitico de cohorte retrospectiva. Se incluyeron todos los pacientes operados de RTR unilateral, que hayan sido operados con un mismo implante. La medición de longitud del miembro inferior fue realizada mediante una radiografía panorámica de miembros inferiores. Se consideró la discrepancia con un punto de corte > 10 mm. Se evaluó el tipo de deformidad o deseje preoperatorio y los resultados funcionales alejados. Resultados: Se incluyeron un total de 60 pacientes, de los cuales 18 presentaron una discrepancia de longitud en los miembros inferiores (30%). De los pacientes que presentaron discrepancia la deformidad más frecuente fue el deseje en valgo en un 55,56% seguido por el varo 38,89% y 5,56% un normoeje. Los resultados según la escala KSS funcional y KSS de la rodilla posoperatorio al seguimiento alejado no demostró diferencias entre ambos grupos. Conclusiones: La incidencia de discrepancia de longitud de miembro inferior tras el RTR fue del 30%. No se requirió  intervención como consecuencia de dicha discrepancia. Los resultados funcionales y dolor al seguimiento alejado no demostraron diferencias entre ambos grupos.