It is generally performed in two unions: the period of fixation after fracture revision and the period of clinical healing of the fracture. (i.e., early and late.) The duration of fracture fixation varies depending on the site and extent of the injury. Prolonged immobilization and persistent edema are the most important causes of joint stiffness. Therefore, early rehabilitation focuses on controlling edema and promoting smooth healing of the fracture. Frequent checks of proper fixation of the plaster splint are needed to prevent plaster complications and to elevate the limb to reduce edema. For stable fractures, once the swelling and pain are reduced (usually 5-7 d after injury), active activities can be started, such as isometric muscle contraction exercises of the fixed limb, which can reduce edema and prevent disuse muscle atrophy. For unstable fractures and compound fracture dislocations, they should be fixed for 3 weeks, and active movement exercises should be started afterwards. the purpose of late rehabilitation is completely different from the early stage, and its treatment focuses on: eliminating residual swelling; softening fibrous scar tissue; increasing ROM of the joint. restoring normal muscle strength and endurance. Restoring hand function coordination and flexibility. Shi Hongcheng, Microsurgery Department, Changchun Orthopaedic and Traumatic Hospital
9.1 Fractures of the metacarpal base of the thumb are divided into 2 types of fractures. Type 1 metacarpal base of the thumb fractures that do not pass through the joint are fixed with a plaster rest or arch splint for 4 weeks after repositioning, and mild displacement or angular deformity of the old fracture has little effect on the function of the thumb. Type 2 metacarpal base fractures of the thumb through the joint (Bennett fractures) are easy to reset but difficult to fix and often require surgical incision and internal fixation, with stitches removed at 2 weeks and plates and casts removed at 6 weeks.
9.1.1 Key points of rehabilitation treatment
9.1.1.1 Fixation period
Active and passive movements of the index, middle, ring and little finger of the injured hand. At the beginning, passive motion is the main focus, and the injured hand is assisted with flexion and extension movements of the interphalangeal joints by the healthy hand. After the local pain disappears, active activities will be the main activity. Three times per d, each activity time to local fatigue-free is appropriate. Local massage, kneading and squeezing of soft tissues of the injured hand, 3 times per d, each time to have a significant local heat sensation is appropriate.
9.1.1.2 After fracture healing
Thumb abduction, adduction, palmar alignment and flexion and extension exercises. At the beginning, passive activities should be performed by holding the thumb with the healthy hand, and the amplitude of movement should not be too large, as long as the fracture site is not painful, 3 times per d for 30 min each time; after 1 week, active activities should be the main activity, and the amplitude of movement should be gradually increased; before doing active and passive movements of the joint, wax therapy such as wax bath should be performed. Paraffin wax has the effect of heat, lubrication and plasticity, which can soften the stiff purpura and joints.
9.1.2 Other metacarpal basal fractures
The fracture is significantly displaced and given a reset with plaster band immobilization for 4 weeks.
9.1.3 Metacarpal stem fracture
After the fracture is repositioned, the finger is immobilized with a cast from the forearm to the proximal phalanx for 6 weeks. The interphalangeal joint is free to move.
9.1.4 Metacarpal neck fracture
9.1.4.1 After fracture revision
Immobilization in a cast or splint for 3 to 6 weeks, maintaining the wrist in 15° to 20° extension and the MP joint in 70° flexion, with IP generally immobilized (if there are no problems with finger rotation).
9.1.4.2 Fixation period
Passive motion of the thumb and healthy finger is the mainstay. active motion is allowed after 1 week, and passive motion of the DIP and PIP joints of the injured finger is performed 3 to 5 d after surgery. Active and passive movements of the MP joint are prohibited to prevent shearing of the fracture end from affecting fracture healing. Active movements of the wrist and elbow and shoulder joints.
9.1.4.3 After 3 to 6 weeks
Remove the splint and start movement of the MP joint of the injured finger, first with passive additional movements to loosen the joint, followed by active plus assisted movements, and when the range of motion of the MP joint improves significantly, active resistance movement training can be started.
9.1.4.4 8 weeks after injury
Perform muscle strength and endurance training.
9.1.4.5 Complications of metacarpal fracture
The main complications are excessive dorsal edema, adhesions of the extensor tendons, joint capsule contracture, and intrinsic muscle contracture.
9.2 Fractures of the phalanges
9.2.1 Fractures of the proximal phalanges
After fracture revision, the metacarpophalangeal joint is flexed 45 and the proximal interphalangeal joint is flexed 90° and immobilized with a dorsal plaster strip for 4-6 weeks.
9.2.2 Middle knuckle fracture
After the fracture is repositioned, it should be fixed in the flexed position if it is angled to the palmar side; it should be fixed in the straight position for 4-6 weeks if it is angled to the dorsal side.
9.2.3 Fractures of the malleolus
After revision, the fracture should be fixed in a plaster or splint with the proximal interphalangeal joint flexed at 90° and the distal interphalangeal joint in the hyperextended position for 6 weeks.
9.2.4 Points for rehabilitation of fractures of the finger bone
9.2.4.1 Fixation period
Active movement of the healthy finger was started on the 2nd postoperative day. If there is no involvement of the flexion and extension of the injured finger, active movement is possible; if there is involvement, passive movement is preferred. Each activity should be to the maximum extent; wrist joint|forearm active activity. When the pain and swelling of the injured finger begins to subside, the injured finger is moved in passive flexion and extension. The range of motion should be determined by the fracture site and symptoms. If the middle and distal phalanges are fractured, the range of motion of the MP joint can be greater; if the proximal phalanges are fractured, the MP joint activity will affect the fracture healing, so it is not advisable to move the MP joint.
9.2.4.2 After removal of external fixation
The focus is on interphalangeal joint flexion and extension exercises. If the fracture heals well, active exercises are performed first. This is followed by passive physiological activities, supplemented by active ones. If the fracture is not healing satisfactorily, the activity should be performed with hand immobilization to protect the fracture site, followed by passive activities of the interphalangeal joint. After the contracture adhesions of the interphalangeal joints are loosened, active movement is the main activity, supplemented by assisted movement, until the mobility of each joint is restored to its maximum range. In distal phalangeal fractures, the fingertips are often combined with allergies and need to be desensitized by rubbing the fingertips with different textured substances, tapping and massaging the fingertips.