1.Fracture of upper limb
Humeral surgical neck fractures are mostly seen in the elderly and are clinically classified into two types: adductor and adductor type Dalian Port Hospital Rehabilitation Department Gao Jian
(1) Adductor type.
It is mostly stable and can be fixed by suspension with triangular scarf for 4 weeks. Do fist clenching and elbow and wrist flexion/extension exercises at an early stage to limit shoulder abduction activities.
(2) Adduction type.
Treatment is more difficult. After repositioning, brake with a triangular scarf for 4-6 weeks. Focus on prevention of pulmonary complications and early functional activities, and restrict shoulder adduction activities. Avoid the occurrence of frozen shoulder and shoulder joint stiffness.
Fractures of the humeral stem Fractures of the middle and lower 1/3 of the humeral stem are easily combined with radial nerve injury. The rate of non-union of the middle humerus fracture is high. X-rays should be reviewed regularly, and if the fracture end appears to be separated, it should be corrected in time. Do more finger extension, fist clenching and shoulder shrugging activities in the early stage to prevent the occurrence of shoulder and elbow joint stiffness, especially in elderly patients.
Supracondylar fractures of the humerus often occur in children and have a better prognosis, but are often prone to combined vascular nerve injury and elbow inversion deformity. After the extension fracture is repositioned, the affected limb is fixed in a 90° elbow flexion functional position for 4-6 weeks with a plaster brace; the flexion type is fixed in the elbow joint extension position. The early symptoms are severe pain, disappearance of radial artery pulsation, pale skin, numbness and abnormal sensation, and ischemic necrosis of forearm muscles can occur if not treated in time, resulting in serious disability. After the external fixation is released, active elbow flexion and extension exercises are done, and violent passive flexion and extension activities are prohibited to avoid the occurrence of ossifying myositis.
The treatment of ulnar radial trunk double fracture is more complicated and the prognosis is poor. The duration of cast fixation for stable fractures is usually 8-10 weeks after repositioning, and the time of removal is decided according to the degree of clinical healing, not too early. Unstable fractures require surgical internal fixation with incision and reduction. Forearm rotation exercises should not be performed during external fixation or before the fracture has healed. Active forearm rotation and wrist flexion and extension exercises can be performed gradually after external fixation is released.
After fixation of the distal radius fracture, finger extension and fist clenching exercises and elbow and shoulder joint activities can be performed. About 4-6 weeks after the release of external fixation, wrist and forearm rotation exercises can be performed.
2.Lower extremity
Femoral neck fractures are more common in the elderly, more women than men, and often occur on the basis of osteoporosis, with a high rate of disability and death. In order to avoid complications caused by long-term bed rest, surgical treatment is currently preferred. Among them, artificial hip arthroplasty is the most frequently used surgical procedure. Functional exercises are usually started 3-5 days after surgery, and when the patient is physically able and the fracture is stable, graded weight-bearing walking under protection is gradually performed 1-2 weeks after surgery.
Femoral stem fractures are prone to various complications during treatment, which can affect weight bearing and activities of the lower limbs. Rehabilitation focuses on prevention of knee extension device adhesions, quadriceps exercises and functional knee exercises should be started as early as possible. Straight leg raising exercises are prohibited until the fracture has healed. Both quadriceps isometric contraction and active ankle and passive patellar movements can be started the day after surgery.
Femoral fracture deformity healing: its femoral stem fracture angular deformity >15°, rotational deformity >20°, or shortening deformity >2.5cm should be surgically corrected.
The purpose of treatment for tibiofibular stem fracture is to restore the length of the lower leg and to correct the angular and rotational displacement between the fracture ends so as not to affect the weight-bearing function of the knee and ankle joints in the future and to avoid the occurrence of traumatic arthritis. In adults, the affected limb should be shortened by <1 cm, the angular deformity should be <15°, and the alignment of the two fracture ends should be at least 2/3 of the way. The knee joint is kept in a straight and neutral position to prevent rotation. After fixation of the fracture, ankle extension and flexion exercises and quadriceps exercises are started. 2-3 weeks later, knee flexion and extension activities are performed. Depending on the degree of fracture healing, graded weight-bearing exercises can be performed gradually with the help of double crutches.
3.Spine fracture
The treatment and rehabilitation of various spinal injuries should follow the following principles.
Simple spinal fracture dislocation according to the general principles of fracture dislocation to reset, fixation and functional exercise. And pay attention to avoid causing spinal cord injury, such as simple compression fractures of the thoracolumbar spine, to flexion type injury is common, after the injury should be supine on a plank bed, and in the fracture site padded about 10 cm high, 3-5 days after the start of supine health care gymnastics, exercises should avoid forward flexion and rotation of the spine. When the acute symptoms are relieved about 2 weeks later, the patient can be allowed to do lumbar hyperextension and turning exercises in the supine position. After turning over, the lumbar extension should be maintained and the shoulder and pelvis should be turned in a straight line, and after turning over, lumbar hyperextension exercises in the prone position should be performed. 6 weeks later, the patient can get up and move around and perform spinal back extension, lateral bending and rotation exercises, but avoid back forward bending movements and postures. After the fracture has healed, the range of motion of the spine and the strength of the lumbar back muscles should be increased.
Spinal fractures with spinal cord injury and subluxation restrictions should be treated as a basic point to facilitate the recovery and reconstruction of spinal cord function.
(1) After the injury, surgery should be performed promptly, the decompression should be complete, the spinal cord compression should be eliminated, and the internal fixation should be secure so that the patient can get the opportunity to turn around early and thus reduce the local re-injury.
(2) early injury should be dehydration therapy.
(3) Actively prevent various complications, especially respiratory and urinary tract infections, decubitus ulcers and venous thrombosis.
(4) For cervical medullary injury, attention should be paid to keep the household magnetic tract unobstructed.
(5) Systemic support therapy, especially important for high spinal cord injury.
(6) Each injury plane patients may apply the auxiliary devices and self-help tools, such as wheelchairs, adaptive ADL appliances.