| Description |
Individuals sustaining fractures to the ankle and/or hindfoot often present with long-term functional limitations. However, there is minimal evidence to guide the management of patients sustaining theses fractures. The purpose of this dissertation was to evaluate the costs of managing patients operatively versus nonoperatively who have sustained a hindfoot fracture, the timing of physical therapy management, and the short-term effects of manual therapy for patients sustaining ankle and/or hindfoot fractures. Systematic reviews have failed to establish if operative management is more beneficial than nonoperative management for improving outcomes in patients sustaining a fracture to the calcaneus. We performed a cost-effectiveness simulation using cost data from Intermountain Healthcare, and probability and utility values from the literature from both a societal and healthcare payer perspective. It was determined that operative fixation was more cost-effective from both perspectives. In addition, there was a greater increase in the probability of requiring a subtalar joint arthrodesis in the group of patients managed nonoperatively, and patients managed nonoperatively had increased time missed from work comparted to those patients managed operatively. The optimal time to initiate a formal physical therapy program after a hindfoot fracture has not been established and previous studies have suggested potential adverse effects of initiating a physical therapy program soon after operative fixation. To address this question, we assessed the outcomes of initiating an EARLY (within 2 weeks after operative fixation) versus a LATE (6 weeks or later after operative fixation) supervised physical therapy program for these patients. In this randomized trial, patients in the EARLY group demonstrated significant improvements in the American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot Scale and the Lower Extremity Functional Scale (LEFS); however due to the high lost to follow-up rate in this study, this conclusion must be tempered. Lastly, the short-term effects of manual therapy for patients sustaining a fracture to the ankle and/or hindfoot that were fixed operatively were evaluated. Patients were randomized to either receive manual therapy or to a sham group. While results indicated no significant differences for mobility, gait, or balance between the group receiving short-term low-frequency manual therapy and the sham group, manual therapy may have a short-term effect on resting muscle stiffness. In summary, the intent of these studies was to help elucidate management strategies that may improve care for patients sustaining fractures to the ankle and/or hindfoot. |
