Post-operative fracture rehabilitation considerations

  Post-operative fracture rehabilitation is to promote the recovery of body functions after fracture and prevent the occurrence of complications and secondary diseases through targeted training. For those who have lost function, training can compensate for the lost function and improve the quality of life. This enables the patient to return to society as soundly as possible. Post-operative rehabilitation should begin as early as possible, usually after the fracture has been repositioned and fixed. After the fracture has been repositioned and fixed, which means that the plaster has been dried or traction has been installed or internal fixation has been performed, and the condition is stable.  Rehabilitation training: rehabilitation training after fracture surgery: generally, it can be divided into three stages: early stage of rehabilitation training: this stage is one to two weeks after the injury, when the injured limb is swollen, painful, the fracture end is unstable and easily re-displaced. Therefore, 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 stabilization of the fracture. The main form of rehabilitation training is the isometric contraction of the injured limb muscles, that is, under the premise of joint immobility, the muscles do rhythmic static contraction and relaxation, that is, what we usually call tense and loose strength, through the isometric contraction of muscles can prevent muscle atrophy or adhesion.  The swelling of the injured limb gradually decreases, the pain decreases, the fracture ends have fiber connections and gradually form scabs, and the fracture site becomes more and more stable. During this period, in addition to continuing muscle contraction training of the injured limb, activities of the proximal and distal unfixed joints of the fracture and the upper and lower joints of the fracture can be gradually restored with the help of the rehabilitation therapist, and the passive activities can be gradually changed to active activities to prevent the decrease of joint mobility of the adjacent joints. In addition, physical therapy can be used to reduce swelling, resolve blood stasis and promote the formation of bone scabs.  Five to six weeks after the injury, the fracture has enough bone scab formation to further expand the range of activities and strength, gradually increase active joint flexion and extension activities from one joint to several joints, prevent muscle atrophy, and avoid joint stiffness. Fractures involving the articular surface often leave significant joint dysfunction; therefore, it is best to start non-weight-bearing active motion of the articular surface about 2 weeks after fixation, and then to fix it afterward. In this way, the mutual extrusion and friction between the articular cartilage surfaces can promote the repair of articular cartilage and make it better shaped, and at the same time, prevent the formation of intra-articular adhesions.  Late stage of rehabilitation training: Clinical healing has been achieved or external fixation has been removed, at this time, bony scabs have been formed, X-ray examination has been revealed, the bones have a certain degree of support, but most of the adjacent joints have decreased joint mobility, muscle atrophy and other dysfunctions. The purpose of rehabilitation in this period is to restore joint mobility and muscle strength of the affected joints, so that limb function can be restored. The main form of rehabilitation training is active movement and weight-bearing exercises of the injured limb joints, so that the joints can quickly return to normal range of motion and normal strength of the limbs. During the recovery period, rehabilitation can be combined with physical therapy and gait training. Home care: Patients with fractures are often bedridden, with little activity and poor digestion, which can cause abnormalities in body metabolism, the most obvious being negative protein balance (i.e. protein consumption is greater than protein intake in the diet); blood loss due to trauma can also lead to loss of nutrients in the body. The healing of fractures and the repair of soft tissues require an adequate supply of nutrients. Therefore, it is very important to provide dietary regimen for postoperative fracture patients. Patients need to eat easily digestible, nutritious and light food, and it is advisable to adopt a high-calorie, high-protein and high-vitamin diet, including more animal liver and tripe, as well as rib soup, chicken, eggs, fish, soy products and milk, and eat more vegetables and fruits, etc.  Patients with plaster fixation should keep their skin clean and dry, and bed sheets need to be flat and wrinkle-free. Patients with paraplegia should be turned every 2 hours and the pressure area should be massaged with 50% alcohol or talcum powder to prevent the occurrence of bed sores.  It is necessary to pay special attention to the fact that after the stabilization of postoperative patients, some of them have depressive reactions, mainly manifested as reluctance to move, loss of appetite and poor sleep, etc. If this psychological state of patients is not relieved in time, it will definitely affect their timely bed activities, and not getting out of bed as early as possible will affect their heart, lung and digestive functions, and even produce venous thrombosis or secondary infections, etc. Therefore, efforts should be made to help patients solve their depressive Therefore, we should try our best to help patients to solve their depression, pay attention to the meaning of their words, and take the initiative to care and considerate them.