足踝骨折治療的新選擇
| 台灣人骨折發生率亞洲第1、世界第7 所有在工作場所受的傷，約有9%為骨折 而骨頭復原一般需要6-8週，有些甚至長達2年 發生骨折的原因
症狀
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足踝關節的解剖圖 腳掌共有26塊骨頭，區分三部分
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| 一般骨折治療方式(取決於類型和嚴重程度) | |||
| 穩定性骨折 | 不穩定骨折 | 應力性骨折 | |
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傳統治療骨折的方法→石膏
傳統的治療方式並無法同時保護骨折部位並讓病人保持活耀，然而長時間的固定會造成復原骨頭強度的減弱。
石膏的不良後果
- 肌肉萎縮
- 在足踝骨折石膏固定6-8周後，小腿肌肉減少20%-32%，力量減少40%-53%。
- 需進行10周的物理治療來回復肌肉表現
- 關節僵硬(肌肉和肌腱固定後會變短且不能伸展，回復需要3個月)
Wolff’s定律-骨頭癒合
現在有一個比石膏固定更好的方式--- 藉由使用氣動式足踝護具達到早期活動   |
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氣動式足踝護具提供早期活動-提早活動可預防僵硬
- 半硬式的外殼設計提供過去只有石膏可以提供的強韌保護
- 可自行調節的氣囊幫助護具與肢體的服貼增加穩定性
- 漸進式的動態脈衝壓力，有效降低血腫，幫助血循
- DUPLEX氣囊可調整充氣效果已達到完整包覆傷口部位達到完美貼效果並提供脈動式加壓緩解傷口腫脹
更好的臨床結果---早期活動
- 踝關節功能復原更好，像是活動範圍。
- 更快回到日常生活
- 負重行走能加強骨質形成使骨骼更強壯→相較於石膏較不會骨質疏鬆
更具經濟效益-直接或間接減少醫療保健費用
$提早恢復工作與勞動
研究顯示，一般使用石膏的平均復原期為106天，使用氣動式足踝護具之病人可比使用石膏之病人提早53天回到工作岡位。
以目前基本工資19047來算，使用氣動式足踝護具可使您多收入25k。
(19047/月=635/天)╳53天－8200頂級氣動式踝護具(長)＝25455元
石膏遠比想像中錢花得多
- 當腫脹消失後，石膏會變得鬆垮失去功能，所以需要經常更換
- 須回診確保無併發症發生
- 國外已有文獻指出，並不推薦長時間使用石膏，使用不當或長時間穿戴石膏會增加併發症的風險
石膏可能會引起的併發症
- 骨筋膜室綜合症(石膏太緊引起)
- 褥瘡及皮膚潰爛
- 皮膚炎
- 感染
- 壓力引起的神經麻痺
- 缺血
提前負重的好處
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參考文獻
- 自由時報電子報2012-8-27 台灣骨折發生率 高居亞洲第1世界第7
- Injuries of the Foot and Ankle in Occupational Medicine: A 1-Year StudyGrimm DJ & Fallet L, The Journal of Foot & Ankle Surgery 38(2): 102-108, 1999
- Ankle FracturesAmerican Academy of Orthopaedic Surgeons(AAOS) 2007
- Functional Treatment and Early Weightbearing After an Ankle Fracture: AProspective StudySimanski CJP et al., J Orthop Trauma 20(2): 108-114, 2006
- Use of a Cast Compared with a Functional Ankle Brace After Operative Treatment of an Ankle Fracture: A Prospective, Randomized StudyLehtonen H et al., Bone Joint Surg. 85A(2):205-211, 2003
- he Law of Bone Remodeling Wolff J., Berlin Heidelberg: New York: Springer, 1986
- Tibia (Shinbone) Shaft FracturesAmerican Academy of Orthopaedic Surgeons(AAOS) 2010
- Functional outcome of surgery for fractures of the ankle: a prospective, randomised comparison of management in a cast or a functional brace Egol KA et al., J Bone Joint Surg. 82B(2):246-249, 2000
- The Aircast Walking Brace versus Conventional Casting Methods: A Comparison Study Kalish SR et al., Journal of the American Podiatric Medical Association 77(11): 589-595, 1987
- The Aircast/AirStirrup System for Graduated Management of Lower Extremity Injuries Stover CN & York JM, Scientific Exhibit Paper, AAOS, San Francisco, 1979
- Comparison of Two Conservative Methods of Treating an Isolated Fracture of the Lateral Malleolus Port AM et al., J Bone Joint Surg 78B(4): 568-572, 1996
- Effects of Immobilization on Plantar-Flexion Torque, Fatigue Resistance, and Functional Ability Shaffer MA et al., PHYS THER 80(8): 769-780, 2000
- Following an Ankle Fracture Early Weight Bearing After Posterior Malleolar Fractures: An Experimental and Prospective Clinical Study Papachristou G et al., The Journal of Foot & Ankle Surgery 42(2): 99-104, 2003
- Mobilization after operation of ankle fractures: Good results of early motion and weight bearing Ahl T et al., Acts Orthop Scand 59(3): 302-306,1988
- The Effect of a Pneumatic Leg Brace on Return to Play in Athletes with Tibial Stress Fractures Swenson EJ et al., Am J Sports Med 25(3): 322-328, 1997
- A Pneumatic Leg Brace for the Treatment of Tibial Stress Fractures Whitelaw GP et al., Clinical Orthopaedics and Related Research 270: 301-305, 1991
- A new Concept in Fracture Immobilization: The Application of a Pressurized Brace Dale PA et al., Clinical Orthopaedics and Related Research 295: 264-269, 1993
- Effects of Intermittent Pneumatic Soft-Tissue Compression of Fracture-Healing in an Animal Model Park SH & Silva M, J Bone Joint Surg 85A(8): 1446-1453, 2003
- Passive Dorsiflexion Flexibility after Cast Immobilization for Ankle Fracture Nightingale EJ et al., Clinical Orthopaedics and Related Research 456: 65-69, 2007
- AAFP 2009 Splints and Casts: Indications and Methods Boyd A et al., Am Fam Physician 80(5):491-499, 2009
- Stress Fracture of the Foot and Ankle American Academy of Orthopaedic Surgeons (AAOS) 2009
- Update on Acute Ankle Sprains Tiemstra J D, Am Fam Physician 85(12), 2012
- Treatment of severe ankle sprain: a pragmatic randomized controlled trial comparing the clinical effectiveness and cost-effectiveness of the three types of mechanical ankle support with tubular bandage. The CAST trial Cooke MW et al., Health Technology Assessment 13(13): 1-121, 2009
- An economic evaluation of early versus delayed operative treatment in patients with closed tibial shaft fractures Sprague S et al., Arch Orthop Trauma Surg 122 :315–323, 2002
- Treatment of Charcot foot and ankle with a prefabricated removable walker brace and custom insole. Verity S et al., Foot and Ankle Surgery 268:1-6, 2007
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