1.Definition of fracture rehabilitation therapy and its relationship with orthopedic treatment?
(1) Fracture rehabilitation is a branch of medicine that specializes in the study of how to promote functional recovery, with the ultimate goal of how to restore function so that patients can get out of pain and go to work and happiness.
(2) Fracture rehabilitation therapy is following the orthopedic surgeon’s postoperative or conservative treatment (cast, splint, etc.) to perform functional exercises so that the patient eventually recovers the function, no matter how beautiful the fracture treatment alignment is, but the ultimate goal is to restore the function, which is also the common result sought by the patient and the doctor. Therefore, fracture rehabilitation has a close relationship with orthopedic treatment.
2.What are the methods of fracture rehabilitation treatment?
(1) Muscle training
Muscle training should be started before surgery and continued until the joint function is fully restored after surgery.
(2) Arthrodesis – joint distraction.
(3) Joint mobility exercises
Continuous passive movement (CPM) is feasible in the early postoperative period, and assisted or active movement is feasible after the pain improves.
(4) Walking training
When postoperative conditions allow, partial weight-bearing with the help of balance bars and walkers can be gradually transitioned to full weight-bearing under the guidance of a rehabilitation specialist.
(5) Non-involved limb and whole body training
Pre- and post-operative training of non-involved limbs and the whole body can help provide good conditions for surgery, avoid post-operative complications such as deep vein thrombosis and respiratory infections, reduce the load on the replacement joint, and enhance cardiopulmonary function and the ability to perform daily activities.
(6) Corresponding hot and cold therapy, electrotherapy, phototherapy and other physical factor therapy
Cold therapy can be used to prevent joint swelling after surgery and after sports training. Heat therapy can be used from one week after surgery to reduce inflammation and swelling and relieve pain. Electrical nerve stimulation can be used for post-surgical analgesia. Light therapy can be used to promote incision healing.
These rehabilitation techniques are very mature in our central hospital and are also the leading level in Mianyang.
3.The best time for fracture rehabilitation treatment? Patient Misconceptions
It takes 100 days to break a bone, after a fracture you should rest fully and wait for the bone to grow well before moving ……” This understanding exists for many people. In fact, this is a misconception, and many fracture patients miss the best time for rehabilitation treatment precisely for this reason, which seriously affects the functional recovery of the limb.
The first day after fracture fixation, you should start systematic rehabilitation; within 1 month after fracture fixation is the key period of rehabilitation, which is important for limb function recovery, missing this period will greatly reduce the functional recovery effect.
A 29-year-old Wang went to a hospital for treatment of a calf fracture and was splinted from the ankle off above the knee after the fixation. After that, Wang seldom moved around and wanted to wait for the bone to grow, but when the splint was removed more than 3 months later, his calf fracture had grown, but his ankle joint became stiff and difficult to bend. Later, he was referred to our department. After investigation, it was found that due to the long-term lack of activities, the ankle capsule and soft tissues had developed serious adhesions, and the ankle joint almost lost its function. This not only brings him secondary trauma and pain, but also affects the functional recovery effect.
4.How to judge the fracture recovery?
(1) No local pressure pain and longitudinal percussion pain of the fracture.
(2) No local abnormal activity.
(3) X-ray film shows that the fracture line is blurred and there is continuous bone scab through the fracture line.
(4) The injured limb can meet the following requirements after the external fixation is released: the upper limb can lift 1 KG of weight forward for one minute; the lower limb can walk continuously for 3 minutes and not less than 30 steps on the flat ground without the aid of crutches.
(5) No deformation at the fracture site for two consecutive weeks of observation.
The main focus is on gentle exercise, such as walking, cycling, etc.; strenuous exercise such as playing basketball is prohibited. Do not play strenuous sports such as basketball, soccer, etc.
5.How to rehabilitate at home after fracture?
(1) The early stage of rehabilitation training, that is, within one to two weeks after the injury. The main purpose of functional exercise in this period is to promote the blood circulation of the affected limb to facilitate the reduction of swelling and stabilize the fracture. The main form of rehabilitation training is to do rhythmic static contraction and relaxation of the injured limb muscles, which is what we usually call tensing and loosening, to prevent muscle atrophy or adhesion through muscle isometry.
(2) The middle period of rehabilitation training, that is, 2 weeks after the injury to the clinical healing of the fracture. During this period, in addition to continuing the muscle contraction training of the injured limb, you can gradually change from passive activities to active activities with the help of your family members to prevent the joint mobility of the joint from decreasing; if your condition allows, you should get up as early as possible to perform whole body activities. In addition, physical therapy can be used to reduce swelling, remove blood stasis and promote the formation of bone scabs.
(3) At the later stage of rehabilitation training, the bony scab has been formed and the bone has a certain degree of support. The main form of rehabilitation training is active activities and weight-bearing exercises of the injured limb joints, so that the joints can quickly return to the normal range of activities and normal strength of the limbs.
6.What are the common complications of fracture rehabilitation? Joint adhesions and ossifying myositis
Joint adhesions are caused by joint bruises, dislocations, fractures, swelling for a long time, and long-term immobility of the limb, mainly manifested as impaired joint extension and flexion, commonly known as “long saliva”, “joint adhesions”, which causes great inconvenience in working life.
a. The recovery of fracture, dislocation and injury is divided into two phases. The first phase is generally the fracture healing period. The second phase generally refers to the functional recovery period. If the fracture is fixed in a cast or after the fracture is repositioned by surgery, this is the first phase, and after the cast is released or after the surgery, this is the second phase, which is the functional recovery period. In other words, only half of the fracture healing plus functional recovery is considered healed.
b. Injuries, fractures, and dislocations in the joint area are likely to cause joint adhesions, which means that functional activities are limited. (unable to extend and bend)
c. Many patients and their families are in a hurry to restore the original state in a short period of time, so they go to massage, pull, press, pull, hang bars, lift stones, etc. They are eager to achieve. Medically speaking: it will cause tissue re-injury, bleeding, aggravated adhesions and even ossification myositis, stiffness, resulting in lifelong disability, can not be cured.
d. Because of joint adhesions patients always want to be well in one or two days. In fact, at that time, the joint bends and extends, but the next day it bounces back to the original. Sometimes even the bones are broken in individual patients.
The joint movement exercises for osteoarthritis are not allowed to be violent. Violence can lead to ligament and its attachment point tear, and even fracture; violence can tear off the periosteum, injury to the periosteal vessels lead to ossifying myositis, once the ossifying myositis, can be declared incurable or incurable.
As an example to illustrate the use of manipulation to lift heavy objects against elbow flexion can only make stiffness worse, and in addition, some families, and even some therapists, cannot resist the temptation to use vigorous passive stretching for slowly improving elbow function. These rough movements that cause significant pain can cause additional injuries, especially ossifying myositis, and must be avoided with care.
7.What to eat after fracture is good for recovery?
Most patients with fractures do not have systemic symptoms, except for the first few days when they may have slight systemic symptoms, so it is enough to choose a varied and nutritious diet similar to that of a healthy person. We should pay attention to making food easy to digest and absorb, and be careful with spicy products (chili, raw onion, mustard, pepper) that have adverse effects on the respiratory and digestive tracts. When the systemic symptoms are obvious, the so-called soft food should be given between normal diet and semi-liquid diet, and the food supplied must contain less dregs, be easy to chew and digest, and must be chopped and cooked softly when cooking. These are the general dietary principles for fracture patients. In order to promote fracture healing faster and better, fracture patients should also take different foods according to the development of their condition in the early, middle and late stages of fracture healing, in order to promote hematoma absorption or bone scab production.
There are four taboos in the diet of fracture patients (avoid eating more meat and bones) The main ingredients of meat and bones are phosphorus and calcium. If a large amount is ingested after the fracture, it will lead to an increase in the inorganic component of the bone, resulting in an imbalance in the ratio of organic matter in the bone, which will hinder the early healing of the fracture).
1, avoid partial food: fracture patients are often accompanied by local edema, congestion, bleeding, muscle tissue damage, etc. The body itself has the ability to resist repairing these, and the body repair tissue stasis and swelling is mainly dependent on a variety of nutrients, it can be seen that the key to ensure the smooth healing of fracture patients is nutrition.
2, avoid eating indigestible things: fracture patients due to fixed casts or splints and restricted activities, coupled with the swelling and pain of the injury, mental anxiety, often appetite. Therefore, food should be nutritious and easy to digest, avoid eating yams, glutinous rice and other easily flatulent or indigestible food, it is appropriate to eat more fruits and vegetables.
3, do not drink less water: bedridden fracture patients are very inconvenient, so they drink less water to reduce the number of urination, so that although the number of urination is reduced, but the patient has less activity, intestinal peristalsis is weakened, coupled with reduced water, it is easy to cause constipation. Therefore, bedridden fracture patients want to drink water, do not have to worry a lot.
4, avoid excessive consumption of white sugar: a large intake of white sugar will cause the rapid metabolism of glucose, thus producing intermediate substances of metabolism, when the alkaline calcium, magnesium, sodium plasma, will be immediately mobilized to participate in the neutralization effect, in order to prevent the blood from appearing acidic. Such a large consumption of calcium will be detrimental to the recovery of fracture patients.