Kalkaneus Kırıklarında İki Farklı Cerrahinin Ayak Fonksiyonu, Ağrı, Denge ve Yürüyüş Özelliklerine Etkisi

Year 2023, Volume: 12 Issue: 2, 256 - 262, 23.06.2023

Şulenur Yıldız , Elif Kırdı , Utku Gürhan , Fatih İnci , Semra Topuz , Nilgün Bek , Erman Ceyhan

https://doi.org/10.53424/balikesirsbd.1096327

Abstract

Amaç: Çalışmamızın amacı, kalkaneus intra-artiküler kırıklarında cerrahi tedavi yöntemlerinden olan açık redüksiyon-internal fiksasyon ve kapalı redüksiyon-internal fiksasyon yöntemlerini ayak fonksiyonu, ağrı, denge ve yürüyüş özellikleri açısından karşılaştırmaktı. Materyal ve metod: Çalışma kapsamında intra-artiküler kalkaneus kırığı sonrasında cerrahi tedavi yapılan 20 hasta değerlendirildi. Bireyler geçirdikleri cerrahi tipine göre açık redüksiyon-internal fiksasyon (n=9) ve kapalı redüksiyon-internal fiksasyon (n=11) gruplarına ayrıldı. Ayak bileği aktif ve pasif dorsifleksiyon eklem hareket açıklıkları, plantar fleksör ve hamstring kas kısalıkları ölçüldü. Ağrı değerlendirmesinde Görsel Analog Skalası Ayak-Ayak Bileği (VAS-FA) formu kullanıldı. Ayak fonksiyonu, Amerikan Ortopedik Ayak-Ayak Bileği Derneği (AOFAS) Ayak Bileği-Arka Ayak Skalası ile değerlendirildi. Denge değerlendirmesinde postüral salınım, stabilite skor ve sınırları değerlendirilirken, yürüyüşün zaman mesafe karakteristikleri incelendi. Bulgular: Gruplar, demografik ve antropometrik parametreler açısından birbirine benzer özellikler göstermekteydi (p> 0,05). Aktif ve pasif dorsifleksiyon eklem hareket açıklıkları, plantar fleksör ve hamstring kas kısalıkları, VAS-FA ve AOFAS Ayak Bileği-Arka Ayak Skalası parametreleri açısından fark yoktu (p> 0,05). Postüral salınım, stabilite sınırı ve skorları ile yürüyüşün zaman ve mesafe karakteristikleri arasında anlamlı fark bulunmadı (p> 0,05). Sonuç: Kalkaneus intra-artiküler kırıklarının cerrahi tedavilerinden açık redüksiyon-internal fiksasyon ve kapalı redüksiyon-internal fiksasyon arasında ayak fonksiyonu, ağrı, denge ve yürüyüş parametreleri açısından fark olmaması nedeniyle komplikasyon riski daha az olan kapalı redüksiyonun tercih edilmesi önerilmektedir.

Keywords

Ağrı, denge, kalkaneus, kırık, yürüyüş

The Effect of Two Different Surgery on Foot Function, Pain, Balance and Gait Characteristics in Calcaneus Fractures

Abstract

Objective: The aim of our study was to compare the surgical techniques which are open reduction-internal fixation and closed reduction-internal fixation in intra-articular calcaneus fractures in aspects of foot function, balance and gait. Materials and methods: In the study, 20 patients underwent surgical treatment after intra- in intra-articular calcaneus fracture were evaluated.Individuals were divided into open reduction-internal fixation (n=9) and closed reduction-internal fixation (n=11) groups according to the type of surgery they underwent. Active and passive ankle dorsiflexion range of motion, plantar flexor and hamstring muscles tightness were measured. Visual Analogue Scale Foot-Ankle (VAS-FA) form was used for pain assessment. Foot function was assessed using the American Orthopaedic Foot& Ankle Society (AOFAS) Ankle-Hindfoot Scale. In the evaluation of balance, postural sway, stability score and limits were evaluated, while the time-distance characteristics of gait were examined. Results: The groups showed similar characteristics in terms of demographic and anthropometric parameters (p> 0.05). There was no difference in terms of active and passive dorsiflexion joint ranges of motion, plantar flexor and hamstring muscle shortness, VAS-FA and AOFAS Ankle-Hindfoot Scale parameters (p > 0.05). There was no significant difference between postural sway, stability limit and scores, and time and distance characteristics of gait (p> 0.05). Conclusions: Since there is no difference between open reduction-internal fixation and closed reduction-internal fixation, among the surgical treatments of calcaneus intra-articular fractures, in terms of foot function, pain, balance and gait parameters, it is recommended to prefer closed reduction with less complication risk.

Keywords

Balance, calcaneus, fracture, gait, pain

References

• Ballardini, G., Florio, V., Canessa, A., Carlini, G., Morasso, P., & Casadio, M. (2020). Vibrotactile Feedback for Improving Standing Balance. Front Bioeng Biotechnol, 8, 94. https://doi.org/10.3389/fbioe.2020.00094
• Besch, L., Radke, B., Mueller, M., Daniels-Wredenhagen, M., Varoga, D., Hilgert, R. E., Mathiak, G., Oehlert, K., & Seekamp, A. (2008). Dynamic and functional gait analysis of severely displaced intra-articular calcaneus fractures treated with a hinged external fixator or internal stabilization. J Foot Ankle Surg, 47(1), 19-25. https://doi.org/10.1053/j.jfas.2007.10.013
• Çolak, İ., Çolak, T., Polat, M. G., Timurtaş, E., Bulut, G., & Gülabi, D. (2018). The Results of Physical, Radiologic, Pedabarographic, and Quality-of-Life Assessments in Patients with Surgically Treated Intraarticular Calcaneus Fractures. J Foot Ankle Surg, 57(6), 1172-1180. https://doi.org/10.1053/j.jfas.2018.06.009
• de Kruijff, L. G. M., Prins, M., van der Krans, A., Hoencamp, R., & van der Wurff, P. (2018). Combat-related foot injuries: impact on gait and functional outcome. J R Army Med Corps, 164(5), 322-327. https://doi.org/10.1136/jramc-2017-000870
• DeWall, M., Henderson, C. E., McKinley, T. O., Phelps, T., Dolan, L., & Marsh, J. L. (2010). Percutaneous reduction and fixation of displaced intra-articular calcaneus fractures. J Orthop Trauma, 24(8), 466-472. https://doi.org/10.1097/BOT.0b013e3181defd74
• Epstein, N., Chandran, S., & Chou, L. (2012). Current concepts review: intra-articular fractures of the calcaneus. Foot Ankle Int, 33(1), 79-86. https://doi.org/10.3113/fai.2012.0079
• Gur, G., Turgut, E., Dilek, B., Baltaci, G., Bek, N., & Yakut, Y. (2017). Validity and reliability of visual analog scale foot and ankle: the Turkish version. The Journal of Foot and Ankle Surgery, 56(6), 1213-1217.
• Holtmann, J. A., Südkamp, N. P., Schmal, H., & Mehlhorn, A. T. (2017). Gastrocnemius Recession Leads to Increased Ankle Motion and Improved Patient Satisfaction After 2 Years of Follow-Up. J Foot Ankle Surg, 56(3), 589-593. https://doi.org/10.1053/j.jfas.2017.01.037
• Işıklar, Z. U., & FE, B. (2006). Kalkaneus kırıkları. TOTBID (Türk Ortopedi ve Travmatoloji Birliği Derneği) Dergisi, 5(1-2), 44-52.
• Kitaoka, H. B., Alexander, I. J., Adelaar, R. S., J, A. N., Myerson, M. S., Sanders, M., & Lutter, L. D. (1997). Clinical Rating Systems for the Ankle-Hindfoot, Midfoot, Hallux, and Lesser Toes. Foot Ankle Int, 18(3), 187-188. https://doi.org/10.1177/107110079701800315
• Lentz, T. A., Sutton, Z., Greenberg, S., & Bishop, M. D. (2010). Pain-related fear contributes to self-reported disability in patients with foot and ankle pathology. Arch Phys Med Rehabil, 91(4), 557-561. https://doi.org/10.1016/j.apmr.2009.12.010
• Mitchell, M. J., McKinley, J. C., & Robinson, C. M. (2009). The epidemiology of calcaneal fractures. Foot (Edinb), 19(4), 197-200. https://doi.org/10.1016/j.foot.2009.05.001
• Nakale, N. T., Strydom, A., Saragas, N. P., & Ferrao, P. N. F. (2018). Association Between Plantar Fasciitis and Isolated Gastrocnemius Tightness. Foot Ankle Int, 39(3), 271-277. https://doi.org/10.1177/1071100717744175
• Otman, A. S., Demirel, H., & Sade, A. (2014). Tedavi hareketlerinde temel değerlendirme prensipleri. Pelikan yayıncılık.
• Šarabon, N. (2011). Development of software for comprehensive analyses of force plate measurements. Kinesiology, 43(2.), 204-212.
• Schepers, T., & Patka, P. (2009). Treatment of displaced intra-articular calcaneal fractures by ligamentotaxis: current concepts' review. Arch Orthop Trauma Surg, 129(12), 1677-1683. https://doi.org/10.1007/s00402-009-0915-8
• Seat, A., & Seat, C. (2020). Lateral Extensile Approach Versus Minimal Incision Approach for Open Reduction and Internal Fixation of Displaced Intra-articular Calcaneal Fractures: A Meta-analysis. J Foot Ankle Surg, 59(2), 356-366. https://doi.org/10.1053/j.jfas.2019.08.007
• Serrador, J. M., Lipsitz, L. A., Gopalakrishnan, G. S., Black, F. O., & Wood, S. J. (2009). Loss of otolith function with age is associated with increased postural sway measures. Neurosci Lett, 465(1), 10-15. https://doi.org/10.1016/j.neulet.2009.08.057
• Stagni, R., Leardini, A., O'Connor, J. J., & Giannini, S. (2003). Role of passive structures in the mobility and stability of the human subtalar joint: a literature review. Foot Ankle Int, 24(5), 402-409. https://doi.org/10.1177/107110070302400505
• Tomesen, T., Biert, J., & Frölke, J. P. (2011). Treatment of displaced intra-articular calcaneal fractures with closed reduction and percutaneous screw fixation. J Bone Joint Surg Am, 93(10), 920-928. https://doi.org/10.2106/jbjs.H.01834
• Walde, T. A., Sauer, B., Degreif, J., & Walde, H. J. (2008). Closed reduction and percutaneous Kirschner wire fixation for the treatment of dislocated calcaneal fractures: surgical technique, complications, clinical and radiological results after 2-10 years. Arch Orthop Trauma Surg, 128(6), 585-591. https://doi.org/10.1007/s00402-008-0590-1
• Wallin, K. J., Cozzetto, D., Russell, L., Hallare, D. A., & Lee, D. K. (2014). Evidence-based rationale for percutaneous fixation technique of displaced intra-articular calcaneal fractures: a systematic review of clinical outcomes. J Foot Ankle Surg, 53(6), 740-743. https://doi.org/10.1053/j.jfas.2014.03.018
• Webster, K. E., Wittwer, J. E., & Feller, J. A. (2005). Validity of the GAITRite walkway system for the measurement of averaged and individual step parameters of gait. Gait Posture, 22(4), 317-321. https://doi.org/10.1016/j.gaitpost.2004.10.005