New Paradigms in Ankle Fracture Rehabilitation

Lay Abstract Objectives and rationale : Over 9 percent of all fractures involve the ankle making it one of the most common fractures in the United States military and in civilian populations. While significant advancement has been made in the operative management of individuals after an ankle fracture requiring surgical fixation , post operative rehabilitation techniques have not kept pace. Notably there h ave been no clinical trials optimizing rehabilitation to improve physical function and quality of life for service members . Given the high incidence and chall enges faced with returning to duty, such research is warranted. For instance, over 50 percent of United States Military personnel report functional limitations with recreational and/or daily activities after an ankle fracture. These early deficits in function do not resolve with time alone, with work showing that at a 5 year follow up, 56 percnet of individuals report some level of disability. The overarching objective of this project is to conduct a pilot clinical trial evaluat ing the efficacy of a n ovel intervention to improve physical recovery within the first year following surg ical fixation of an ankle fract ure . The intervention is informed by our prior work which identified gaps in standard of care treatment where we have measured significant reductions in the calf muscles ’ ability to generate force quickly over time. These variables were more closely related to physical performance than muscle strength alone. In addition, we show that while standard of care does improve strength , it does not address the speed at which a person generates force , which is important for both battlefield activities and everyday tasks , such as climbing stairs . We propose to test our new A nkle M uscle P ower (AMP) program against standard of care to evaluate for improvements in patient reported physical function and quality of life. We will also perform assessments of physical performance as well improvements the calf muscles ’ ability to generate force quickly. These steps are necessary to evaluate the initial efficacy of the program for subsequent use within military treatment facilities. Topic area s of 202 4 CTRA 2024 announcement addressed: The proposed grant is in direct response to the fiscal year 2024 peer reviewed orthopaedic research program clinical translational research award call for development of rehabilitation strategies to facilitate retention of return to duty. The proposed gran t addresses the specific subcategory 2b. Return to Duty , through a novel rehabilitation program to enhance service members ability to return to duty within one year following an ankle fracture requiring surgical fixation. In addition, the proposed project directly addresses 2 primary focus areas identified in the 2021 PRORP stakeholders meeting: 1) Leveraging of existing and emerging technologies to optimize musculoskeletal injury care and 2) Optimization of rehabilitation strategies. Further as directed by clinical translation award, we will evaluate this intervention through a pilot clinical trial as indicated in the award i nstructions . Lastly, the proposed trial aligns with newly released Defense Health Agency strategic research plan for musculoskeletal injury , goal M5: which seeks to identify and optimize rehabilitation protocols and guidelines for service members. Types of patients helped and how will it help them: The results of this study will directly benefit individuals that suffer a traumatic ankle fracture that requires surgical fixation. This fracture is one of the most common types suffered by service members and civilians and can result in significant dysfunction . To date , there has n ot been a clinical evaluating a treatment to improve physical function and quality of life after ankle fracture . Thus, the outcomes of this study address an important unmet need. Our long - term goal is to establish a set of clinical guidelines for post operative rehabilitation that allow service members to return to their units without profile restrictions in less than a year. Potential clinical applications and benefits: Potential clinical applications include an easy to use exercise therapy that can be implemented in various military treatment facilities for individuals suffering an ankle fracture. The proposed intervention would benefit civilians and families of military personnel as it can be deployed in any number of settings. Proposed work will have short - and long - term impact s on patient care and restoration of function : The outcomes of the proposed project align with the goals for the military benefit by testing a novel intervention that can be performed with few additional resources . Furthermore, we will evaluate the short - and long - term implications of this therapy to restore the Service Member s ability to return to duty. The program directly addresses the most common physical impairments associated with an ankle fracture in one cohesive treatment.