The use of early immobilization in the management of acute soft-tissue injuries of the knee: results of a survey of emergency physicians, sports medicine physicians and orthopedic surgeons

Sommerfeldt, Mark; Bouliane, Martin; Otto, David; Rowe, Brian H.; Beaupré, Lauren A

doi:10.1503/cjs.004014

Cited by 8 publications

(11 citation statements)

References 29 publications

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“…The results for the function and effect domain show that the Opencast ® provided somewhat less support than the conventional synthetic cast; however, there was no significant between-group difference in the amount of pain relief. The severity of pain experienced after an ankle sprain depended on the amount of inflammation present, which could be aggravated by movement of the injured tissues[ 11 , 12 ]. Therefore, this suggests that the injured ligamentous tissue was well protected and immobilized despite the patients’ subjective feelings otherwise.…”

Section: Discussionmentioning

confidence: 99%

Patients’ perspectives on the conventional synthetic cast vs a newly developed open cast for ankle sprains

Min

Yoon

Chung

et al. 2020

WJO

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BACKGROUND Orthopedic physicians typically apply a cast to immobilize a body part that has been injured. There have been no significant structural changes or advances in synthetic casts since the development of the modern cast. The Opencast ® is a recently developed type of cast that allows ventilation and direct visual inspection of the skin to avoid cast-related complications. Although this novel cast appears to have more benefits than the conventional synthetic cast, its clinical efficacy and advantages have not been established. AIM To investigate the clinical efficacy and advantages of the newly developed Opencast ® based on patients’ perspectives in those with ankle inversion injury. METHODS A specifically designed questionnaire consisting of 19 items was used to compare patients’ opinions and concerns of the Opencast ® and the conventional synthetic cast. The items were focused on subjective patient satisfaction, discomfort, and adverse effects while wearing the cast. Patients with an ankle inversion injury diagnosed as a high-grade ankle sprain were enrolled. The subjects were randomized and instructed to fill the questionnaire after wearing a synthetic cast or an Opencast ® for 2 wk. They were then required to fill the questionnaire again, after switching to the alternative type of cast for 2 more weeks. RESULTS A total of 22 subjects participated in the study. The synthetic cast appeared to be more rigid and stable than the Opencast ® , but there was no significant difference in the amount of pain relief. The likelihood of adverse effects when wearing the synthetic cast was significantly higher. Patient satisfaction tended to be rated higher after wearing the Opencast ® . Opencast ® showed more subjective vulnerability than the synthetic cast, but there was no significant difference in the redo rate. Patients were more anxious about removal of the synthetic cast than of the Opencast ® . CONCLUSION The results indicate that the Opencast ® could replace the conventional synthetic cast as it offers increased patient satisfaction, which would in turn increase compliance to treatment.

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Section: Discussionmentioning

confidence: 99%

Patients’ perspectives on the conventional synthetic cast vs a newly developed open cast for ankle sprains

Min

Yoon

Chung

et al. 2020

WJO

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“…There was a lack of clear high‐level evidence on the best immobilisation strategy for specific knee injuries, advice on weight bearing and timing of commencement of range of motion exercises. A survey of emergency physicians, sports medicine physicians and orthopaedic surgeons on their practice patterns regarding the use of early immobilisation in common acute soft tissue injuries showed that emergency physicians were more likely to prescribe immobilisation than other specialties, demonstrating that there is variation in care between different health providers . Although complete knee joint immobilisation using either a splint or locked hinged brace may protect tissues and alleviate pain, there can be harmful effects of prolonged joint immobilisation such as joint stiffness and muscle atrophy .…”

Section: Discussionmentioning

confidence: 99%

“…70 Although complete knee joint immobilisation using either a splint or locked hinged brace may protect tissues and alleviate pain, there can be harmful effects of prolonged joint immobilisation such as joint stiffness and muscle atrophy. 41,70,71 Prescription of gentle range of motion exercises, basic quadriceps strengthening exercises and consideration for early follow up for rehabilitation and clinical review is essential to avoid any deleterious effects of prolonged immobilisation.…”

Section: Discussionmentioning

confidence: 99%

“…A survey of emergency physicians, sports medicine physicians and orthopaedic surgeons on their practice patterns regarding the use of early immobilisation in common acute soft tissue injuries showed that emergency physicians were more likely to prescribe immobilisation than other specialties, demonstrating that there is variation in care between different health providers . Although complete knee joint immobilisation using either a splint or locked hinged brace may protect tissues and alleviate pain, there can be harmful effects of prolonged joint immobilisation such as joint stiffness and muscle atrophy . Prescription of gentle range of motion exercises, basic quadriceps strengthening exercises and consideration for early follow up for rehabilitation and clinical review is essential to avoid any deleterious effects of prolonged immobilisation.…”

Section: Discussionmentioning

confidence: 99%

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Review article: Best practice management of common knee injuries in the emergency department (part 3 of the musculoskeletal injuries rapid review series)

Strudwick

McPhee

Bell

et al. 2017

Emerg Medicine Australasia

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Knee injuries are a common presentation to the ED and are often difficult to assess and definitively diagnose due to the patient's acute pain, effusion and guarding. The quality of ED care provided to patients with fractures or soft tissue injuries of the knee is critical to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common knee injuries in the ED. Databases were searched in 2017, including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites. Primary studies, systematic reviews and guidelines were considered for inclusion. English-language articles published in the past 12 years that addressed the acute assessment, management, follow-up plan or prognosis were included. Data extraction of included articles was conducted, followed by quality appraisal to rate the level of evidence where possible. The search revealed 2250 articles, of which 54 were included in the review (n = 8 primary articles, n = 28 systematic reviews, n = 18 guidelines). This rapid review provides clinicians managing fractures and soft tissue injuries of the knee in the ED, a summary of the best available evidence to enhance the quality of care for optimal patient outcomes. There is consistent evidence to support undertaking a thorough history and physical examination, including the application of special tests and clinical decision rules for imaging. In the undifferentiated knee injury, expedited follow up and further imaging is recommended to improve patient outcomes and cost-effectiveness.

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“…A limitation in the passive ROM of affected joints is termed a joint contracture, and this can be detrimental for joint performance. [1,2] The development of contractures can arise as a consequence of injury/disease (requiring extended periods of immobility), [2][3][4][5][6] or due to treatment (prolonged use of bracing). [7] The pathophysiology of joint contractures is progressive in nature, where increases in the duration of immobilization increases the severity of ROM loss.…”

Section: Introductionmentioning

confidence: 99%

Embryonic movement stimulates joint formation and development: Implications in arthrogryposis multiplex congenita

Zhou

2021

BioEssays

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Arthrogryposis multiplex congenita (AMC) is a heterogeneous syndrome where multiple joints have reduced range of motion due to contracture formation prior to birth.A common cause of AMC is reduced embryonic movement in utero. This reduction in embryonic movement can perturb molecular mechanisms and signaling pathways involved in the formation of joints during development. The absence of mechanical stimuli can impair joint cavitation, resulting in joint fusion, and ultimately eliminate function. In turn, mechanical stimuli are critical for proper joint formation during development and for mitigating AMC. Studies in experimental animal models have provided a greater understanding on the molecular pathophysiology of congenital contracture formation as a consequence of embryonic immobilization. Elucidation of how the mechanical signaling environment is transduced to initiate a biological response will be necessary to gain a deeper understanding of how mechanical stimuli are intertwined in the molecular regulation of joint development.

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The use of early immobilization in the management of acute soft-tissue injuries of the knee: results of a survey of emergency physicians, sports medicine physicians and orthopedic surgeons

Cited by 8 publications

References 29 publications

Patients’ perspectives on the conventional synthetic cast vs a newly developed open cast for ankle sprains

Patients’ perspectives on the conventional synthetic cast vs a newly developed open cast for ankle sprains

Review article: Best practice management of common knee injuries in the emergency department (part 3 of the musculoskeletal injuries rapid review series)

Embryonic movement stimulates joint formation and development: Implications in arthrogryposis multiplex congenita

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