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Table of Contents
CASE REPORT
Year : 2022  |  Volume : 8  |  Issue : 2  |  Page : 172-175

Multiple fractures of foot in landslide and physiotherapy: Case study


Department of Musculoskeletal Sciences, Krishna Institute of Medical Sciences, KIMSDTU, Karad, Maharashtra, India, Department of Musculoskeletal Sciences, Krishna Institute of Medical Science, Karad, Maharashtra, India

Date of Submission25-Nov-2021
Date of Acceptance24-Nov-2022
Date of Web Publication11-Jan-2023

Correspondence Address:
Sandeep Babasaheb Shinde
Department of Musculoskeletal Sciences, Krishna Institute of Medical Sciences, Karad, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sujhs.sujhs_1_21

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  Abstract 


Here is the case report of a multiple foot fractures due to landslides. landslides are the gravitational downward and outward movements of soil. landslides develop in unstratified homogeneous soils or are induces by certain types of stratification. The causes are excessive load pressures at the head of the slope. Landslides are rare to happen. Calcaneal fractures are rare but debilitating injuries. The annual incidence of fracture was 11.5 per 100,000, and occurred 2.4 times more frequently in males than females. Presenting a case of 40-year-old male with left comminuted calcaneal fracture and crushed injury on the right ankle due to landslide. He was conscious when brought to the hospital, where immediate measures were taken. He was operated on for the same and was managed surgically by open reduction internal fixation with plating. He was referred to physiotherapy. He presented with pain and swelling. Further, he was assessed and followed physiotherapy treatment. The results suggested reduction in pain and edema after immediate physiotherapy approach. For the cases of crush injury or calcaneal fracture initial treatment, cryotherapy followed up by weight bearing is found to be effective for the reduction of pain.

Keywords: Comminuted calcaneal fracture, crushed injury, landslide


How to cite this article:
Avaghade RR, Shinde SB. Multiple fractures of foot in landslide and physiotherapy: Case study. Santosh Univ J Health Sci 2022;8:172-5

How to cite this URL:
Avaghade RR, Shinde SB. Multiple fractures of foot in landslide and physiotherapy: Case study. Santosh Univ J Health Sci [serial online] 2022 [cited 2023 Feb 1];8:172-5. Available from: http://www.sujhs.org/text.asp?2022/8/2/172/367558




  Introduction Top


Landslides, mass movements of rock, debris, or earth down a slope, are natural processes that have shaped much of the earth's landscape. Landslides occur when the downward forces, including the force of gravity, exceed the cohesive forces holding the landmass together, and a failure of the slope-forming material results. several causes contribute to the occurance of landslides such as geological factors; morphological factors such as tectonic uplift, glacial rebound, and erosion of the hill slope or toe; physical factors such as heavy rainfall, rapid snow melt and earthquakes; and anthropogenic factors such as mining, deforestation, and excavation of the hill slope or toe.[1]

The calcaneus is the most frequently fractured tarsal bone, with calcaneal fractures accounting for 65% of tarsal injuries and approximately 2% of all fractures. The treatment of calcaneal fractures currently remains controversial because of the suboptimal results of treatment and the incidence of complications. Complications of calcaneal fractures occur in the acute and late stages and after operative or nonoperative treatment. Acute complications include swelling, fracture blisters, and compartment syndromes, and these acute complications influence treatment choices for calcaneal fracture. Late complications include arthritis, malunion including calcaneofibular abutment, and heel pad problems.[2]


  Case Report Top


A 40-year-old male while parking his bike, experienced an accidental landslide. Due to the landslide, the patient was pushed into the river. Because of the constant flow of water, the patient somehow managed to hold on to the tree. While hanging on the tree, the patient got hit on his both the feet, by the boulder which was flowing in the water. The patient experienced severe pain and called out for help. The nearby villagers gathered and helped him to get down the tree and he was immediately taken to the Krishna Hospital. Here, the necessary investigations were done, and he was diagnosed with left comminuted calcaneal fracture and crushed injury on his right ankle. No other significant injuries were seen in the patient. On the same day, the wound was cleaned, and debridement of the right wounded foot was done. Then, the right foot was bandaged. Later, the patient was operated on for the calcaneal fracture. Open reduction internal fixation with plating was done. The patient was then shifted to the general ward. It was observed that there was nonpitting edema present on both lower limbs. According to the Visual Analog Scale, the pain intensity was 6.2/10 on the right, and 4.6/10 on the left. Movements of the upper limb were complete and painful due to trauma. Further, the patient was referred to physiotherapy. Consent of the patient was taken before assessing the patient and starting the treatment.


  Physiotherapy Exercise Programme Top


Day 1–2

  • Toe curls - 10 reps × 1 set
  • Active-assisted exercises for hip joint - 10 reps × 1 set
  • Breathing exercises: segmental, apical, and diaphragmatic - 10 reps × 3 sets
  • Active-assisted exercises for


    • Shoulder: Flexion, extension, abduction, and adduction - 10 reps × 3 sets
    • Elbow: Flexion and extension - 10 reps × 3 sets
    • Wrist: Ulnar and radial deviation - 10 reps × 3 sets


  • Desensitization methods[3]: general shaking movements, gentle rub, light touch, warm and cold test tubes, and joint compression.


Day 3

  • Toe curls – 15 reps × 1 set
  • Active-assisted exercises for hip joint – 15 reps × 1 set
  • Active-assisted knee exercises for knee joint – 10 reps × 1 set
  • Breathing Exercises: segmental, apical, and diaphragmatic – 10 reps × 3 sets
  • Active-assisted exercises for


  • Shoulder: flexion, extension, abduction, and adduction – 10 reps × 3 sets
  • Elbow: Flexion and extension – 10 reps × 3 sets
  • Wrist: Ulnar and radial deviation – 10 reps × 3 sets.


Day 4

  • Toe curls - 15 reps × 2 sets [Figure 1] and [Figure 2]
  • Active exercises for hip joint – 10 reps × 2 sets
  • Active knee exercises for knee joint – 15 reps × 2 sets
  • Breathing exercises: Segmental, apical, and diaphragmatic – 10 reps × 3 sets
  • Active-assisted exercises for


  • Shoulder: Flexion, extension, abduction, and adduction – 10 reps × 5 sets
  • Elbow: Flexion and extension – 10 reps × 5 sets
  • Wrist: Ulnar and radial deviation – 10 reps × 5 sets.
Figure 1: a, b and c shows normal appearance of bony prominence of right ankle. d,e and f shows extra articular calcaneus fracture of left ankle

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Figure 2: a and b shows Postoperative radiograph showing of extra articular calcaneus fracture managed with open reduction internal fixation with plating of left ankle

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Day 5

  • Toe curls – 10 reps × 2 sets
  • Active exercises for hip joint – 10 reps × 2 sets
  • Active knee exercises for knee joint – 10 reps × 2 sets
  • Breathing exercises: Segmental, apical, and diaphragmatic – 10 reps × 3 sets
  • Active-assisted exercises for


  • Shoulder: Flexion, extension, abduction, and adduction – 10 reps × 5 sets
  • Elbow: Flexion and extension - 10 reps × 5 sets
  • Wrist: Ulnar and radial deviation - 10 reps × 5 sets.


Follow-up: After the removal of the plaster cast

  • After receiving physiotherapy treatment for 5 days, the pain was reduced, and the swelling was reduced
  • After the follow-up of 45 days, the patient was reassessed, and home exercise program was given, which included cryotherapy and active exercises for the hip, knee, and ankle
  • Closed chain stabilization exercises:[4] 10 reps × 5 sets. They are a safe and more effective for early ambulation and recovery of muscle strength.



  Radiographic Presentation Top



  Results Top


  • pain was reduced after receiving the physiotherapy sessions for 5 days as mentioned in [Table 1]: Edema reduced after five sessions of physiotherapy, which included exercises like toe curls
  • the ranges of the hip, knee and ankle joints were also improved after the treatment sessions as showed in [Table 2], [Table 3] and [Table 4].
  • Movements of lower limb
Table 1: Visual analog scale

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Table 2: Hip range of motion

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Table 3: Knee range of motion

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Table 4: Ankle range of motion

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  1. Hip
  2. Knee
  3. Ankle.



  Discussion Top


Many articles were reviewed and discussed, regarding calcaneal fracture management and crush injury. The calcaneum is the most commonly fractured tarsal bone accounting for 1% to 2% of all fractures. Hemorrhage following injury is usually the initial cause of swelling, followed by a build-up of interstitial edema. A number of methods to reduce swelling have been advocated, including elevation of the limb, ice therapies, foot pumps, and pulsed shortwave diathermy. Ice produces superficial vasoconstriction, and its most important effects appear to be in the reduction of pain following acute trauma and a reduction of the metabolic rate of the undamaged cells around the area.[5]

An article suggested mobilizing and nonweight bearing (on the affected side) for 6 weeks, followed by 6 weeks of partial weight bearing. Management was done by standardized physiotherapy rehabilitation regimen as the operative treatment arm.[6]

Internal fixation of comminuted fractures by means of open reduction is a surgically challenging procedure that can be associated with complications. Due to the risk of early soft tissue and bone complications, as well as the prevalence of late posttraumatic arthrosis associated with open surgical repair of comminuted fractures, alternative methods of treatment that reduce the incidence of these complications would be accepted.[7]

Complications involved are: (a) Compartment syndrome: this is a complication that can commonly occur in the ankle and foot. The main causes are bleeding and edema or externally applied pressure from a tight plaster cast, which compromises the microcirculation, (b) Algodystrophy: another complication after ankle fracture is algodystrophy which may occur even after a minor injury. The condition is characterized by a constant dull aching pain.[8] Furthermore, the patient could be advised to take proper rest and continue the given exercise program at home.


  Conclusion Top


This case study concluded that physiotherapy treatment in the early stages is essential. For the cases of crush injury or calcaneal fracture, initial treatment, including active exercises for distal joints, and cryotherapy followed up by partial weight bearing and total weight bearing, is found to be effective for the reduction of pain.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Singh A, Kanungo DP, Pal S. Physical vulnerability assessment of buildings exposed to landslides in India. Nat Hazards 2019;96:753-90.  Back to cited text no. 1
    
2.
Lim EV, Leung JP. Complications of intraarticular calcaneal fractures. Clinical Orthopaedics and Related Research®. 2001;391:7-16.  Back to cited text no. 2
    
3.
Shah PS, Shinde SB. Effect of desensitization methods during the early mobilization phase in post-fracture conditions of upper extremity. Asian J Pharm Clin Res 2018;11:93-6.  Back to cited text no. 3
    
4.
Jagdishbhai SR, Shinde SB. Effect of closed kinetic chain exercises in subjects with proximal femur fracture operated with dynamic hip screw and plate fixation. 2017;11:98. Available from: www. ijpot. com. [Last accessed on 2017 Apr 11].  Back to cited text no. 4
    
5.
Buzzard BM, Pratt RK, Briggs PJ, Siddique MS, Tasker A, Robinson S. Is pulsed shortwave diathermy better than ice therapy for the reduction of oedema following calcaneal fractures? Preliminary Trial Physiother 2003;89:734-42.  Back to cited text no. 5
    
6.
Griffin D, Parsons N, Shaw E, Kulikov Y, Hutchinson C, Thorogood M, et al. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: Randomised controlled trial. BMJ 2014;349:g4483.  Back to cited text no. 6
    
7.
Bozkurt M, Ocguder DA, Ugurlu M, Kalkan T. Tibial pilon fracture repair using Ilizarov external fixation, capsuloligamentotaxis, and early rehabilitation of the ankle. J Foot Ankle Surg 2008;47:302-6.  Back to cited text no. 7
    
8.
Lesic A, Bumbasirevic M. Ankle fractures. Curr Orthop 2004;18:232-44.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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Abstract
Introduction
Case Report
Physiotherapy Ex...
Radiographic Pre...
Results
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