In
June Paul Harnett, Consultant Orthopaedic Surgeon and ISEH Consultant
in Sport & Exercise Medicine spoke at the ISEH Masterclass to a
group of sports team doctors, general practitioners, physiotherapist and
nutritionist. He gave them an overview what recent advances have been made both intrap-operatively and post-operatively to help rehabilitate patients faster:
"I treat complex lower limb fractures and pelvis fractures every week at Kings College Hospital. I wanted to share some of the new evidence based methods of treating simple and complex intra-articular fractures in 2017. I still see people treated ‘ elsewhere’ with simple ankle fractures for example, who are told to ‘keep your foot in plaster for 6 weeks and don’t walk on it ‘ we now know that the traditional method just slows down the recovery by months.
Intra-operative techniques:
Major trauma centres have become a lot better at treating fractures in recent years, because of the increase volume and sub-specialist interest in complex trauma. The speed of recovery has improved a lot in the last ten years or so. We have a better understanding of the skin biology, fracture healing biology with stronger implants that are specific to the exact part of the bone they are treating allows the surgeon to treat these fractures mininmially invasive percutaneous osteosynthesis(MIPO) techniques. These techniques allow earlier range of movement exericses and earlier weight bearing.
Post-operatively we’ve really made some major gains too. We now only put people into plaster for minimum amount of time, for knees and tibias’ almost never in ankle fractures usually only 2 weeks post operatively. At the two week post op mark we encourage patients to start aggressive range of motion exercises to avoid the scar tissue settling in, we encourage partial weight bearing, as we know that weight bearing promotes stronger bone healing. Too many times we see people over protecting their fracture and end with disuse osteopenia. We briefly talked about DVT’s, flying, the beneficial use of low molecular weight heparin. Finally, just for fun, I showed some gnarly major trauma cases, including pelvis and acetabular trauma and open tibia fractures, where some of the same principles apply to gain sturdy fixation of the fracture to allow early weight bearing and an early recovery, including free flap skin transplants, and then we drank some wine and talked about the heat wave…."
For upcoming ISEH masterclasses please see our events calendar.