Results of early rehabilitation of patients with unstable injuries of the pelvic ring and combined injuries of the lower extremities

Abstract

Background. The functional outcome of surgical treatment of unstable fractures the pelvic ring largely depends on the early activation of patients and timely dosed load taking into account concomitant injuries of the lower extremities. Purpose – to develop a program of early rehabilitation of patients with unstable fractures of the pelvic ring and combined injuries of the lower extremities and to investigate the results of its application. Materials and Methods. The material is clinical and radiological examination protocols of 42 patients with unstable fractures of the pelvic ring (types B and C) as a dominant injury with combined injuries of the lower extremities, which made up the main group A (n = 25) and the control group B (n = 17). All patients underwent surgical stabilization of fractures in the trauma department of the «City Clinical Hospital Of Emergency And Urgent Medical Care Named After Prof. O. I. Meshchaninov, Municipal Non-Profit Enterprise Of The City Council Of Kharkiv», and in the early postoperative period, rehabilitation programs were used: in group B – generally accepted in this hospital, in group A – a new one, which was distinguished by the presence of educational program, isometric exercises for the paravertebral and gluteal muscles, ideomotor exercises and relaxation techniques of manual therapy for the muscles of the leg on the side of the acetabular fracture, fractures of the femur and tibia, static exercises for the muscles of the pelvic floor. Methods: clinical, including pain assessment using a numerous rating scale (NRS); functional status after pelvic fractures according to the Majeed scale, assessment of kinesiophobia according to the Tampa TSK scale; radiological; statistical. Results. The result of the application of the developed early rehabilitation program was the active and conscious participation of patients of the main group in the treatment process, a positive emotional mood, the absence of fear of movement in the limbs during exercise therapy (TSK for group A (31.7 ± 10.6) points; for group B (46.6 ± 13.2) points), a significant decrease in the intensity of the pain syndrome (NRS (3.6 ± 2.4) points and (4.8 ± 1.8) points, respectively). These factors contributed to the early activation of patients with a significant (p < 0.05) decrease in the average duration of bed rest in group A. Conclusions. The application of the developed early rehabilitation program for this contingent of patients revealed a significant prevalence of excellent and good results in group A compared to group B (61.8 and 72.6%, respectively) and a decrease in unsatisfactory results (14.2 and 7.4%, respectively).