Due to the sudden, crushing and mass injury characteristics of earthquakes, limb trauma accounts for most of the earthquake casualties. Most of the fractures of earthquake casualties are open, multiple, comminuted and obviously displaced. Although most of these casualties have been rehabilitated by the medical personnel through active early treatment, a considerable number of them will be left with different degrees of disability and handicap. If rehabilitation measures are taken early, the functional recovery of post-operative earthquake limb fracture casualties can be effectively prevented and improved, allowing them to return to society. In view of the trauma characteristics, post-injury treatment process and current status of these earthquake orthopedic casualties, the author summarizes the effects of rehabilitation interventions on returning earthquake casualties (supporting hospital) and local earthquake casualties (this hospital) as follows for colleagues’ reference and more valuable opinions. He Jianyong, Department of Rehabilitation Medicine, Mianyang Central Hospital
Data and Methods
1. General information.
Patients came from 15 cases of local earthquake injured (outpatient, inpatient) and 100 cases transferred back to earthquake injured (outpatient, inpatient).
2.Treatment methods.
Fracture fixation period
1.Reducing limb swelling Elevate the injured limb with a pillow or suspension belt to reduce limb swelling. In addition, after elevating the limb, the patient can actively move the distal unaffected joints, such as fingers and toes, and massage centripetally to accelerate blood circulation, which can effectively reduce edema.
2.Pay attention to complications For the casualty wearing plaster, if there is severe pain, loss of sensation or paralysis, blackened fingers or toes, weakness of the limb, inability to move, etc., it is necessary to remove the plaster frame and readjust the wearing.
3.Physical therapy For non-metal internal fixation, short wave or ultra short wave, direct current electrotherapy, low frequency pulse magnetic therapy, massage therapy along the perpendicular direction to the fracture line, etc. are used to promote fracture healing.
Fracture healing period
1. Early movement of uninjured limbs and joints
Such as pendulum activity of the upper limb, fist clenching, knee flexion and extension, etc. can effectively prevent joint stiffness and contracture. For joints with good fracture healing and stiffness, the joint can be loosened with heat therapy (wax therapy); if wearing a cast or splint, medical personnel should instruct the injured person to perform isometric muscle contraction exercises, especially for the muscles in the cast, in order to reduce muscle atrophy and adhesions, and for those with tissue contracture and serious adhesions, continuous traction (orthopedic device fixed in a functional position) and passive movement (passive movement is the basic method to correct joint The basic method of contracture is to use the plasticity of soft tissues and the effect of adhesions release. First, each movement should reach the maximum range of motion of the joint; second, the degree of force should be limited to mild pain; third, each time the joint flexes and extends to the limit, a total of 10 rounds), the movement should be smooth, gentle, rhythmic, in order not to affect the obvious pain is appropriate. In addition, the parts that are not fixed should carry out certain muscle strength training (muscle strength 0-1 level to perform booster exercise; muscle strength 2-3 level to active exercise training, can also perform booster exercise, do booster exercise, booster should be small; muscle strength 4 level to perform resistance training), such as the lower limb with a short cast, the patient can practice straight leg lift, single-leg bridge exercise, etc., to strengthen the muscle strength of the hip and quadriceps.
2.Activate out of bed as early as possible
If the patient walks with a walker, in addition to regular turning of the patient in bed to prevent bed sores, the patient should also be taught to move around in bed, sit up and do simple transfer activities. In addition, patients with lower limb fractures fixed by surgery or plaster can walk with a walker without weight bearing.
3. Restoration of ADL ability and working ability
The upper extremity is treated with occupational therapy and pre-vocational training to improve motor skills and techniques. Lower limbs are trained with gait to restore normal motor functions. Try to let the patient groom and eat by himself, and hold the strength circle and exercise ball in his hands to achieve the purpose of activity. Without affecting the healing of fracture fixation, the patient can support others or use the strength of double crutches to get out of bed early, move early and bear weight at night, so that the amount of activity can be gradual from small to large.
4.Physical therapy
Physiotherapy can improve the blood circulation of the limb, reduce inflammation, swelling, pain, adhesions and muscle atrophy, and promote fracture healing. Physiotherapy includes: ①Thermal therapy, such as conduction heat therapy (wax therapy, Chinese medicine ironing), radiation heat therapy (such as infrared, light bath) can be applied. ②Ultra-short wave therapy or low-frequency magnetic therapy can strengthen the metabolic process in the osteogenic regeneration area and make the fibroblasts and osteoblasts appear earlier. Low-frequency magnetic therapy is more suitable for fractures in thin soft tissue areas (such as hand and foot fractures), while deep fractures are suitable for ultrashort wave therapy. This method can be performed outside the cast, but is prohibited when there is internal fixation with metal plates. ③ Audio electrical or ultrasonic treatment can reduce scarring and adhesions. Results.
According to the assessment objectives (fracture healing: fracture alignment and scab formation; presence or absence of pseudarthrosis; presence or absence of deformity healing; presence or absence of ossifying myositis; joint mobility; muscle strength; limb length and circumference; sensory function; ADL ability), a 95% optimization improvement rate and an 80% ADL rehabilitation rate were achieved.
Discussion.
About 5% of the earthquake casualties had pressure smash injuries combined with nerve damage (the site and degree of nerve damage should be examined in detail, and electromyography should be used to determine the nature and degree of nerve damage for treatment reference. For closed nerve injury, surgery can be withheld and the next treatment will be determined after 3 months of rehabilitation depending on the recovery. For open nerve injury, especially when the trauma is infected, regardless of whether the nerve is broken or not, we will not operate, and then do nerve repair surgery after 3 months of observation, depending on the situation. (Early functional exercise after limb surgery should not be neglected)
After limb injury and fracture surgery, functional exercise is often not performed because the physician is worried about the impact of the fracture site’s solidity on fracture healing and the injured person is afraid of pain, which can lead to muscle atrophy, tendon contracture, osteoporosis, joint stiffness and other complications, which directly affects the degree and quality of limb function recovery. Another phenomenon is the unscientific activities such as over-activity and premature weight-bearing activities, which can lead to serious problems such as plate breakage, extraction or nail pull-out and fracture deformity. During the rehabilitation process, the condition of the fixed part and the color and sensory activity of the distal limb should be closely observed, and any abnormalities should be contacted with the doctor to avoid re-injury.
Therefore, early, correct and scientific functional exercise of the limb is essential for the functional recovery after limb trauma and fracture surgery. In the early postoperative period (within 2 weeks), the muscle stretching and contraction activities of the injured limb should be carried out under the condition that the joints adjacent to the fracture do not move. In the middle period (3-8 weeks), in addition to continuing the muscle relaxation activities of the injured limb, gradually loosening the joint and moving the joint. The main purpose of functional exercise is to strengthen the active flexion and extension activities of the injured limb joints, such as weight-bearing exercise, so that the joints can recover to the normal range as soon as possible and the muscle strength of the limbs can be close to normal, so that the compatriots can return to social life and work as soon as possible.