I. Reset
(a) Early fracture repositioning
The fracture repair can be carried out smoothly. There are two types of repositioning methods: manual repositioning and surgical repositioning. If the time of resetting is delayed too long, it will cause difficulties in fracture repositioning.
Bone removal and repositioning is the first step in treating fractures, so, in principle, anatomical alignment should be sought for every fracture, while for some fractures, which have some difficulties in repositioning, although they are not completely restored to the anatomical position, the fracture heals without affecting the function of that injured limb, called functional alignment. In treating fractures, it is important to pay attention to the functional restoration of the injured limb, rather than one-sidedly and mechanically forcing anatomical alignment. If the local swelling of the injured limb is severe and even skin blisters are formed, the repositioning is more difficult. At this time, we should still strive for fracture repositioning, and if we wait passively for the swelling to disappear, we often delay the timing of repositioning. If the injured person is in coma, shock, or combined with visceral or cranial injuries, it is necessary to concentrate on resuscitation first, and only after the general condition is stabilized can the fracture be reset.
(B) Standard of reset
Generally speaking, the fracture should be reset to anatomical alignment or close to anatomical alignment. However, in clinical practice, due to the differences in fracture site, fracture type, post-injury swelling of the fracture, equipment conditions and technical level of the repositioner, etc., every effort should be made to achieve the best degree of recovery of the affected limb according to the specific situation. The principle is that the fracture repair does not affect the function of the patient’s limb.
1. Upper extremity: humerus fracture, more shortening deformity and lateral displacement, slightly more than 5°-10° into the angle, have little impact on the function of the affected limb. The requirements for ulnar flexor fractures are more stringent. If the lateral displacement does not exceed 50% and the angular deformity is below 5°-10°, it will have little effect on the function of forearm rotation and posterior rotation. The ulnar flexor must be repaired at the same time.
2.Lower extremity: The shortening of the lower extremity fracture should not exceed 2cm, too much shortening will break the line and cause pain in the hip and lower back over time. Rotational displacement should be corrected by all means. Internal or external rotation of the lower limb will affect the gait of the lower limb.
3.Children: Children’s fracture rectification requirements are wider. Generally, angular and rotational deformities below 15°, as well as mild shortening or lateral displacement, can be compensated by strong shaping ability in children’s development, and there can be no obvious functional impairment later.
4.Intra-articular fracture: intra-articular fracture, bone demolition line through the joint surface, the repositioning requirements are higher, should strive for anatomical repositioning. For intra-articular fractures, if the anatomical repositioning is not satisfactory, surgical internal fixation should be considered as appropriate.
(iii) Methods of repositioning
1.Manual repositioning: Among the treatment methods of fracture, manual repositioning is the most widely used and safer. After repositioning, the shape and length of the fractured limb must be carefully checked to see if it has returned to normal. After giving appropriate and effective external fixation, x-ray fluoroscopy or radiographs should be taken to confirm the results of the reset. If the fracture is poorly repositioned, it will be corrected as needed.
2, traction reset: traction can be used as a method of reset, but also to maintain the reset measures. It is mainly used for fractures that cannot be repositioned by traction or are unstable after repositioning.
3.Cut repositioning: It is an important cause of fracture non-union and should be chosen carefully.
Fixation
Appropriate and effective fixation is one of the keys to fracture healing. It can continue to maintain the alignment of the fracture after repositioning and prevent the shear rotational force and angular activity that are detrimental to fracture healing. There are two types of fixation methods commonly used. After fracture reduction, external fixation is used for external fixation of the injured limb, including small splints, plaster bandages, and continuous traction. After the fracture is repositioned, the internal fixation of the injured limb is internal fixation, including screws, plates, triple-edged nails, intramedullary pins, etc. After internal fixation, it is often necessary to use external fixation for short-term or long-term synergistic fixation to make the therapeutic effect more effective.
Three, functional exercise
Early and reasonable functional exercise can promote blood circulation of the affected limb, reduce muscle atrophy, maintain muscle strength, prevent joint stiffness and promote fracture healing. Therefore, all fixed limbs should be given proper muscle contraction and relaxation exercises. For joints that are not fixed, the patient should be encouraged to do active functional exercises in a timely manner, and gradually strengthen the weight-bearing exercises when the fracture end has reached clinical healing.
There are two forms of functional exercise in clinical practice: active and passive exercise.
(I) Active exercise
According to the patient’s mobility, muscle contraction and relaxation exercises and all-way movements of the unfixed joints are performed as early as possible without affecting the displacement of the fracture end to promote blood circulation, enhance physical fitness, reduce the systemic reaction to trauma, and prevent joint stiffness, so active exercises should be carried out throughout the fracture repair process.
(B) Passive exercise
1.Massage: Applicable to the limb with swelling at the fracture end, help the swelling to subside through light massage.
2.Passive joint activities: In the early stage of fracture fixation, a few patients are afraid to do active exercises due to the fear of pain. It has a certain effect on the early elimination of swelling, prevention of muscle atrophy and adhesion, and joint capsule contracture, but the operation should be gentle, so as not to displace the fracture again and aggravate the local trauma.
(C) Functional exercise precautions
1.Functional exercise must be performed under the guidance of medical personnel.
2, functional exercise should be based on the degree of stability of the fracture, can start from light activity gradually increase the amount of activity and activity time, can not be too hasty, if the sudden violent activity and the bone dislocation, but also to prevent some patients under the correct guidance of medical personnel dare not exercise, such patients should be patient persuasion work.
3, functional exercise is to accelerate the fracture healing and restore the function of the affected limb, so the activities that are beneficial to the fracture should encourage the patient to adhere to exercise, and the activities that are unfavorable to the fracture healing should be strictly prevented, such as the abduction activities of the adductor humeral surgical neck fracture, the inversion activities of the inversion fracture, the extension activities of the supracondylar humerus fracture, the flexion activities of the flexion fracture, the rotation activities of the forearm fracture, the tibiofibular stem fracture The dorsal extension and flexion activities of the lower radius extension fracture should be prevented.