do you think a physiotherapist should attempt to mobilize the ankle into dorsiflexion / plantarflexion with that kind of external fixator? should the ankle pivot around the pin?
[quote]alexus wrote:
do you think a physiotherapist should attempt to mobilize the ankle into dorsiflexion / plantarflexion with that kind of external fixator? should the ankle pivot around the pin? [/quote]
Where have you been…?
I went to the website.
The description that starts out with “The purpose of this frame is to…” is not substantial enough for me to research.
So I tried and clicked on links (towards the bottom left) but nothing happened. I was hoping to read case studies. I also tried clicking on the Video link and nothing happened.
So I did a search and found a PDF that goes into more detail. It looks promising: more precise than the traditional outer cast; and less invasive than permanent plates and pins-which are NOT as guaranteed as many orthos would have the layperson believe.
One can make the argument that all established tools were once new (and possibly looked at with suspicion and disdain when first introduced). Regardless, there are learning curves involved. And, of course, the website won’t mention any potential complications (that would be poor salesmanship). And how skilled will the medical staff be who applies this technology?
Lots of unanswered questions.
A good starting point for me would be getting my hands on peer-reviewed studies.
Ah.
I be more specific…
I had a pretty serious injury to both my ankles around 12 years ago now. My right foot was externally fixated - kind of like that. Not exactly like that. That set-up is as close to my set-up as I could find, however.
There was a pin through my calcaneus in that plane. There were two pins going into the tibia in that plane. The connection between them… Was a little different, unfortunately, but that set-up is as close to mine as I could find.
Physiotherapy - she seemed to believe that she could grab hold of the foot and pull the foot into dorsiflexion and plantarflexion.
Looking at the picture… Thinking about how the bones move with dorsiflexion and plantarflexion… Thinking about the way the external fixator is fixating so as to prevent movement…
Was she right or not right?
Seems to me… The set-up would prevent dorsiflexion / plantarflexion (that that is part of the point of the set-up)? Assuming the pin was going through the fulcrum of dorsiflexion / plantarflexion (is it? I don’t know enough / my brain isn’t working) then should the bone be able to rotate round the pin or is that a bad idea (e.g., keeping the wound site open)?
Actually I’m mostly interested in whether it is possible for the ankle to dorsiflex / plantarflex with that setup or whether the set-up is trying to prevent dorsiflexion / plantarflexion. Seems to me that it is… Attempts to dorsiflex would result in the pins in the tibia being forced into the tibia. But my bio-mechanics isn’t to be trusted…
Well, the risk of infection cannot be completely eliminated. That’s one of the more obvious risks. I wouldn’t be surprised if 10-20 percent of users had some level of infection.
To your specific question, you should get the exact name and model of the device that was applied to your ankles. Without knowing the intended use - as well as the limitations - of the device that was applied to your ankles, I can’t give an objective answer.
The website you provided shows an image of the bottom pins that (to my eyes) go through the calcaneus. This is not the “fulcrum” as you put it. I believe you are referring to the site where the tibia meets the talus.
Let’s hypothetically say that a patient has a device that allows a certain range of dorsi/plantar flexion. Even if that’s the case, poor design, less than optimal placement, many other factors can - based on the inherent design of such devices - drive the pins into the tibia.
This is why knowing the exact model of your device is important. Did its design (intended or not) allow dorsi/plantarflexion?
This is also why reading peer-reviewed studies (as opposed to the marketing brochure on the company’s website) is important.
I’m not sure that we are on the same page…
I think that somebody should be able to tell by looking at the picture of the thing whether it is preventing dorsiflexion / plantarflexion or not.
i have limited formal study of physics / biomechanics and i feel like i don’t have enough words or enough knowledge…
if you jam a pencil into the middle of something round (like a pancake) the pancake can spin round and round the pencil…
if you jam a pin through the calcaneus just like the picture, and pins through the tibia just like the picture, and then connect them up just like the picture (since i can’t find a more precise one)…
… then would the calcaneus spin round the pin that is jammed through it (for ankle dorsiflexion and plantarflexion) or not? perhaps not because of the way it is connected up to the pin jamming into the tibia which would prevent precisely that kind of movement?
or perhaps i’m thinking about this all wrong…
[quote]alexus wrote:
Physiotherapy - she seemed to believe that she could grab hold of the foot and pull the foot into dorsiflexion and plantarflexion.
Was she right or not right?
[/quote]
You’re asking for a crystal clear answer in a muddy scenario.
What was the therapist’s justification for attempting dorsi/plantar on you? Presumably, she was trained in the application of the particular device you had on. If not, and she was merely working off a hunch, that would be shocking yet certainly possible.
And your description of the device that you had:
[quote]alexus wrote:
…kind of like that. Not exactly like that. That set-up is as close to my set-up as I could find, however…
[/quote]
can be clarified (as I stated in an earlier post) by obtaining the exact model of device that was applied to you.
I propose that, based on the model, some devices allow dorsi/plantarflexion. Whether or not such a design was the one that you had appears to be the answer you seek.
And even if a device that allowed a certain amount of dorsi/plantar is applied on a patient, I can easily see an incompetent fool place enough pressure on the tibial pins when trying to dorsiflex.
So, contrary to what you may think, we are on the same page. I prefer to have more information such as the model that was applied to you before I can give an objective view.
I’m not sure what your end game is to all this. Do you suspect that the therapist was negligent? If so, are you contemplating legal action? If you are (and I have zero issues with ANYone taking legal action against incompetent MDs, PTs, Trainers), one of the things that your counsel will want to know will be the specific type of model that was applied to you.
no, i’m voting for stupid.
i’m not planning on any kind of legal action or complaint.
i told her that her doing that felt odd (the pins rammed into my bones were producing weird sensations and i was concerned about oozing from the entry / exit points). i asked her whether she had asked the surgeon whether it was alright for her to be doing that… and she looked at me oddly and didn’t say anything. just went back to massaging and smiling.
perhaps she thought ‘screw you (for suggesting i ask the surgeon) i will just massage and smile and then your toes will go all horribly clawed from my failure to do joint manipulations and stretching of your toes and midfoot to prevent muscle / tendon shrinking… just as your dorsiflexion will be limited from my not moving your ankle through its range of motion - screw you’.
probably i credit her with far too much…
if she didn’t have instructions from the surgeon about the device… then i guess i figured there was a standardized protocol for what you do with people with external fixture devices kind of like that. i mean… if she had have had instructions from the devices manufacturers presumably she just would have said that… possibly.
curiosity. i’m just curious is all. i suspect that if you held the tibia as a fixed point and then moved the ankle into dorsiflexion with the device the calcaneus would be prevented from moving. i think it wants to move down down and around (a stake jammed through the scap / torso would prevent scapula rotation and arm raising).
perhaps.
i’m interested in what the physiotherapy curriculum has to offer an orthopedic physiotherapist who (presumably) finds themself fairly frequently in the position of doing physiotherapy with people with external fixture devices.
i am interested in whether there is a standard protocol for whether it is or isn’t okay to attempt to move joint segments which would involve pins rotating around inside bones (like how an ear-ring bisecting the earlobe can be rotated around in order to prevent the edges healing to the ear-ring).
or whether there is a standard protocol for… what? asking the surgeon? asking the device manufacturers?
i’m interested for my own curiosity. knowledge for knowledge’s sake.
[quote]alexus wrote:
Ah.
I be more specific…
I had a pretty serious injury to both my ankles around 12 years ago now. My right foot was externally fixated - kind of like that. Not exactly like that. That set-up is as close to my set-up as I could find, however.
There was a pin through my calcaneus in that plane. There were two pins going into the tibia in that plane. The connection between them… Was a little different, unfortunately, but that set-up is as close to mine as I could find.
Physiotherapy - she seemed to believe that she could grab hold of the foot and pull the foot into dorsiflexion and plantarflexion.
Looking at the picture… Thinking about how the bones move with dorsiflexion and plantarflexion… Thinking about the way the external fixator is fixating so as to prevent movement…
Was she right or not right?
Seems to me… The set-up would prevent dorsiflexion / plantarflexion (that that is part of the point of the set-up)? Assuming the pin was going through the fulcrum of dorsiflexion / plantarflexion (is it? I don’t know enough / my brain isn’t working) then should the bone be able to rotate round the pin or is that a bad idea (e.g., keeping the wound site open)?
[/quote]
From the look of that device it looks like it would pretty much prevent any dorsiflexion/plantarflexion. The fulcrum for dorsiflexion/plantarflexion is further forwards in the foot than that.