RESUMEN
CONTEXT: Pertrochanteric hip fractures in sportive young adults are mainly caused by a high-energy trauma and treated in the same way as in the older population, using an osteosynthesis immediately followed by a rehabilitation program for several months. The current standard is not to remove osteosynthesis material, similar to the case of older patients. CASE PRESENTATION: A 45-year-old male cyclist experienced a right pertrochanteric femoral fracture, treated with cephalomedullary nails. After 9 months of adequate rehabilitation, weakness of the quadriceps musculature and functional complaints persisted, objectified through an isokinetic strength test and a significantly reduced score on the Hip Disability and Osteoarthritis Outcome Score questionnaire. The patient was unable to return to his previous level of cycling performance. MANAGEMENT AND OUTCOME: After exclusion of structural bone complications, nerve injury, and central sensitization, the functional complaints and strength deficiency were hypothesized to be related to the osteosynthesis material. Therefore, the hardware was removed 9 months after the first surgery, and the rehabilitation was continued for another 20 weeks. Very soon after the removal of the hardware, the functional complaints disappeared with a remarkable improvement of the Hip Disability and Osteoarthritis Outcome Score. The isokinetic strength test showed complete recovery of muscle strength 20 weeks after osteosynthesis removal, and preinjury cycling performance values were obtained 9 months posthardware removal. CONCLUSION: Despite an adequate rehabilitation following a hip fracture, sporty young adults may fail to reach their previous level of functioning. Osteosynthesis removal may be indicated in this sportive population to reach complete muscle strength and functional recovery. The management of hip fractures in the sportive young adult and the identification of patients who may benefit from removal of the hardware require more research.
RESUMEN
PURPOSE: This study aimed to ascertain the value of postoperative physiotherapy after open temporomandibular joint (TMJ) surgery and provide a usable approach for practitioners. MATERIALS AND METHODS: The authors performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of literature concerning the results of postoperative physiotherapy after open TMJ surgery to evaluate its effect on rehabilitation. PubMed Central, Web of Science, Cochrane Library Plus, CINAHL, and EMBASE were used to conduct this search and all articles up to April 1, 2018 (total, 675 articles) were included. Risk of bias in nonrandomized controlled trials (non-RCTs) and other observational studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) scale. The Cochrane Collaboration's tool was used for evaluating RCTs. Maximal mouth opening (MMO) before and after surgery was evaluated, as was the physiotherapeutic protocol used during the postoperative period. Evaluation of lateral movement and pain also was included, if this information was provided. RESULTS: Initially, 675 articles were found, 6 of which were included after screening. Risk of bias was found to be unclear in the included RCTs and rather high in comparative and noncomparative articles. Three studies concluded that patients who received postoperative physiotherapy had a significantly larger increase in MMO (P < .05) compared with patients who did not receive any postoperative physiotherapy. No difference in lateral movement was found (P > .05). Mean visual analog scale pain score was significantly lower in patients who were treated with physiotherapy according to 2 of the included articles (P < .05). CONCLUSIONS: Based on the current scientific literature included in this systematic review, it can be concluded physiotherapy after open TMJ surgery plays an important role in achieving good postoperative results. The authors provide a scheme for its effective use.