|Year : 2002 | Volume
| Issue : 1 | Page : 39-41
|Disability assessment after fracture acetabulum
BD Athani, SP Chatterjee
All India Institute of Physical Medicine & Rehabilitation, Mumbai, India
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|How to cite this article:|
Athani B D, Chatterjee S P. Disability assessment after fracture acetabulum. Indian J Orthop 2002;36:39-41
Following acetabular fracture, the impairments or disabilities arise due to following complications:
- Subluxation and dislocation of hip joint
- Avascular Necrosis of head of femur
- Stiffness of hip
- Deformity (fixed)
- Shortening of lower extremity
- Chronic neurological pains
- Secondary traumatic osteoarthritis
Impairment: Impairment is a permanent or transitory psychological, or anatomical loss and/or abnormality for example a missing or defective part such as an amputated limb, paralysis after polio, etc.
Functional Limitation: Impairment may cause functional limitations which are the partial or total inability to perform those activities necessary for motor, sensory, or mental functions such as walking, seeing, speaking, reading, writing, etc.
Disability: Disability in which functional limitation and/or impairment is a causative factor, is defined as an existing difficulty in performing one or more activities such as self-care, social relations and economic activity.
Under the statutes of Workman's Compensation, disability may be divided into three periods, which are:
1. Temporary total disability is that period in which the injured person is totally unable to work. During this time he received orthopaedic or other medical treatment.
2. Temporary partial disability is that period when recovery has reached the stage of improvement so that the person may begin some kind of gainful occupation.
3. Permanent disability applies to permanent damage or to loss of use of some part of the body after the stage of maximum improvement, from orthopaedic or other medical treatment, has been reached and the condition is stationary.
General guidelines for assessment of locomotor disability
Lower extremity is assessed for two components viz. mobility component and stability component separately.
I. Mobility component:
For assessment of mobility component, range of motion and strength of muscles are taken into account.
a)Range of Motion: Total value of mobility component is 90% with equal weightage to hip, knee and ankle joint ie. 30% for hip, 30% for knee and 30% for ankle joint. Loss of mobility of hip joint movement x .3 will give % disability with reference to ROM.
b)Strength is evaluated using manual muscle testing.
Manual muscle testing grades in terms of % of disability are interpreted as below[Additional file 1]
Combining values for mobility component:
You thus have 2 values, one for ROM and another for strength. For combining values of mobility
component formula devised is
% of mobility component = a + b (90-a)
% of mobility component = a + b (90-a)/90
Where a = higher value, b = lower value
Disability % of ROM and strength is thus combined to compute % loss of mobility component as
per the above procedure.
II. Stability component
Total value of stability component is 90%. It can be evaluated by two methods:
i) Scale method
ii) Clinical method
In clinical practice it is convenient to use the clinical method, which is based on activities.
Assessment of stability using clinical method:
Nine different activities as listed below are evaluated, with 10% for each rating of disability, making it 90% total:
- Sitting cross legged
- Kneel standing
- Standing on both legs
- Standing on one leg
- Walking on plane surface
- Taking turns
- Walking on slope
Mobility and stability both are then averaged to get % of disability. Extra points are given for pain, fixed deformities, Contractures and shortening.
Fixed Deformity in functional position 3%
Fixed deformity in nonfunctional position 6%
Pain with Severe interference in function 9%
Pain with moderate interference in function 6%
Pain with mild interference in function 3%
Shortening First ½" Nil
For every ½" after that 4% each
Maximum extra points, which can be given, should not exceed 10%. They are added to % of disability to arrive at final figure.
I. Mobility component:
a) ROM: Since there is minimal movement at hip, there is 100% disability of range. 100 X 0.3 = 30%
b) Strength - relatively inefficient abductors and extensors.
The strength of muscles around the hip and corresponding % of disability is as follows:[Additional file 2]
For assessment of disability due to physical impairments, the following steps are to be followed and computed:
c) (a+ b) Mobility component
ALGORITHMS OF DISABILITY ASSESSMENT
MOBILITY STABILITY EXTRA POINTS
(A) (B) (C)
ROM + Strength Clinical Method Combining formula
Total disability = Average of A + B and add C
S P Chatterjee
All India Institute of Physical Medicine & Rehabilitation, Haji Ali Park, Mahalaxmi, Mumbai - 400 034.
Source of Support: None, Conflict of Interest: None