Rehabilitation of Lower Extremity Trauma: a Review of Principles and Military Perspective on Future Directions

Abstract

The rehabilitation of individuals with lower extremity injury is a common but complex problem for the surgical and rehabilitative teams. Basic science tenets of fracture and soft tissue reconstruction and healing guide postoperative weight-bearing and range of motion protocols. In addition to the physiological complications associated with the injury severity, patient outcomes are often influenced by other factors such as patient compliance, pain, depression, and the negative effects of immobility. As a result, novel rehabilitative protocols to include early weight bearing, continuous passive motion, psychosocial intervention, and multimodal pain management are becoming more popular to facilitate rehabilitation and improved patient outcomes. Further supporting the need for this shift in paradigm thinking are outcome studies of both civilian and military trauma patients that demonstrate the negative impact that psychological, social, and economical factors have on outcomes. This report highlights the experience that our team has had in instituting comprehensive rehabilitation strategies to treat injured service members with complex lower extremity trauma from combat.

Real-time monitoring of mechanical cues in the regenerative niche reveal dynamic strain magnitudes that enhance bone repair

“…Clinically, it would be beneficial to leverage the potential of local mechanical therapies via early loading, since later stage interventions offer limited benefit to vulnerable cases at risk of non-union. Due to the lack of understanding of early loading and technologies to quantify it in vivo, current rehabilitation protocols for fractures treated with open reduction and internal fixation are typically non-weight bearing for 6-12 weeks ( 34 ).…”

Low-Load Resistance Training With Blood Flow Restriction Improves Clinical Outcomes in Musculoskeletal Rehabilitation: A Single-Blind Randomized Controlled Trial

“…It is widely accepted within both the exercise science and rehabilitation medicine domains that to elicit significant gains in muscle strength and hypertrophy requires lifting loads ≥70% of an individual’s 1-repetition maximum (1-RM) for a given movement ( American College of Sports Medicine, 2009 ; Garber et al, 2011 ). However, for patients undergoing MSK rehabilitation, heavy-load resistance training (RT) can be contraindicated ( Slysz et al, 2016 ) due to pain, muscle weakness and functional limitations preventing the attainment of these recommended heavier-loads ( Hoyt et al, 2015 ). Patients with MSK injuries are often requested by their therapist to reduce the training load, potentially limiting the desired neuromuscular response to treatment and delaying the attainment of rehabilitation goals.…”

Factors Affecting Compliance With Weight-Bearing Restriction and the Amount of Weight-Bearing in the Elderly With Femur or Pelvic Fractures

“…To date, however, the relationship between the amount of weight-bearing and weight-bearing time as well as bone mineral density or functional recovery is not wellknown [10]. A study reported that too heavy weight-bearing at the initial stage after surgery may adversely affect the surgical and reconstructive outcome stability [11]. Some suggested that weight-bearing should be restricted for 2-6 weeks depending on the fracture site [12].…”

“…Hoyt et al [11] reported that although there are differences on the fracture site and operation method, partial weight-bearing or non-weight-bearing postoperatively is usually performed in the rehabilitation stage for patients with lower extremity fracture and reconstructive surgery. In general, patients were encouraged to perform early mobilization and to gradually increase their weightbearing until they attain full weight-bearing.…”