Early rehabilitation of hand fractures with robotic orthosis. Case report
DOI:
https://doi.org/10.1016/j.rccot.2017.11.004Keywords:
exoskeleton, robotic orthosis, DASH score, EVA scoreAbstract
Background: The present cases study reveals technological advances in the treatment of hand fractures performed by the F-CIBER-HAND research group in Manizales - Colombia, integrating the surgical intervention by Hand Orthopedic Surgeon, early mobilization Indicated by Physiatry, the conventional rehabilitation by Physiotherapist specialized in Orthopedics and Traumatology, and passive mobilization therapy whit robotic orthoses.
Materials and methods: Four patients were selected: patient with complex intra-articular fracture in the head of the 5 th right metacarpal, patient with a fracture in the base of the 4 th left metacarpal, patient with diaphyseal fracture of the 5th right metacarpal, and patient with subcapital fracture of the 2 nd left metacarpal, who were treated according to the four therapeutic moments described, with follow-up of their individual clinical evolution.
Results: In all patients was evident functional recovery of the hand according to the DASH scale, decrease of pain intensity according to analogous visual scale, and recovery of the joint mobility arc. In addition, all the patients returned satisfactorily to the daily life activities and jobs.
Discussion: It was concluded that with specialized surgical management and early rehabilitation complemented with robotic orthoses, the functionality of the hand was improved, pain decreased, there was gain of the articular arch and reinsertion to daily activities. The purpose of the study is to generate clinical evidence that specialized interdisciplinary management and the use of robotic orthoses improve the clinical condition of patients with hand fractures.
Evidence level: IV.
Downloads
References
Stanton JS, Dias JJ, Burke FD. Fractures of the tubular bones of the hand. J Hand Surg Eur. 2007;32:626-36. https://doi.org/10.1016/J.JHSE.2007.06.017
Nakashian N, Lauren, puntero, Brett D. Owens & Jennifer Moriatis Lobo La incidencia de fracturas de metacarpianos en la población estadounidense. Am Assoc Hand Surg. 2012;7:30-426.
Secretaría de Salud Pública de Manizales. Estadísticos de fracturas de Mano. RIPS, IPS, Manizales, Colombia. Cálculos año 2014.
de Putter CE, Selles RW, Polinder S, Panneman MJ, Hovius SE, van Beeck EF. Economic impact of hand and wrist injuries: health-care costs and productivity costs in a population-based study. J Bone Joint Surg Am. 2012;94:e56. https://doi.org/10.2106/JBJS.K.00561
Gaston RG, Kuremsky MA. Postoperative infections: prevention and management. Hand Clin. 2010;26:265-80. https://doi.org/10.1016/j.hcl.2010.01.002
Balaram AK, Bednar MS. Complications after the fractures of metacarpal and phalanges. Hand Clin. 2010;26:169-77. https://doi.org/10.1016/j.hcl.2010.01.005
Markiewitz AD. Complications of hand fractures and their prevention. Hand Clin. 2013;29:601-20. https://doi.org/10.1016/j.hcl.2013.08.012
Meals C, Meals R. Hand fractures: A review of current treatment strategies. J Hand Surg. 2013;38A:1021-31. https://doi.org/10.1016/j.jhsa.2013.02.017
Gallagher KG, Blackmore SM. Intra-articular hand fractures and joint injuries: part II - therapist's management. En: Skirven TM, Osterman AL, Fedorczyk J, et al., editores. Rehabilitation of the hand and upper extremity. 6.a ed Filadelfia: Elsevier Mosby; 2011. p. 417-38. https://doi.org/10.1016/B978-0-323-05602-1.00033-7
Farmer SE, James M. Contractures in orthopaedic and neurological conditions: A review of causes and treatment. Disabil Rehabil. 2001;23:549-58. https://doi.org/10.1080/09638280010029930
Thien TB, Becker JH, Theis JC. Rehabilitation after surgery for flexor tendon injuries in the hand. Cochrane Database Syst Rev. 2004:CD003979. https://doi.org/10.1002/14651858.CD003979.pub2
Hayes Inc. Medical Technology Directory. Continuous Passive Motion (CPM) Following the Micro fracture Procedure. Lansdale, PA: Hayes Inc; 2011.
Hayes Inc. Medical Technology Directory. Mechanical Stretching Devices for the Treatment of Joint Contractures of the Extremities. Lansdale PA: Hayes Inc.; 2011.
Moreno JD, Moreno Julián A. Prototipo EMMRA-1. Exoesqueleto de mano y muñeca con aplicaciones de rehabilitación y asistencia. VIII Congreso Iberoamericano de Tecnologías de Apoyo a la Discapacidad. Iberdiscap. 2015.
Gómez JF, Moreno JD, Gil GA, Velásquez J, Orozco CH. Rehabilitación de la mano con ortesis robóticas. Rev Colomb Med Fis Rehab. 2016;16:174-9. https://doi.org/10.28957/rcmfr.v26n2a7
