In order to facilitate clinical rehabilitation, fracture rehabilitation is roughly divided into two stages: fracture fixation period (early stage) and fracture healing period (late stage).
1.Fracture fixation period (early stage) Continuous swelling is the main cause of disability after fracture, early rehabilitation treatment focuses on eliminating swelling and controlling pain.
(1) Elevate the limb: the distal end of the limb must be higher than the proximal end, and the proximal end should be higher than the heart level.
(2) Active exercise: Active exercise is the most effective, feasible and least expensive method to eliminate edema fluid.
1) Active movement on each axis of motion of the upper limb of the affected side that is not fixed in the joint, with assistance if necessary. Each time for about 10 min, several times a day. Be careful to gradually increase the intensity of the activity so as not to affect the stability of the fracture end. The upper limb should pay attention to shoulder joint abduction, external rotation and hand functional position.
2) When the fracture is basically stable and the soft tissues are basically healed, perform rhythmic isometric contraction exercises of the fixed muscles to prevent disuse muscle atrophy and to make the fracture ends fit together to facilitate bone healing. Each exercise should be performed for about 10 min, several times a day.
3) Functional exercises should be started as early as possible for intra-articular fractures, which can promote the repair and shaping of the articular cartilage surface and reduce intra-articular adhesions. Generally, after 2 to 3 weeks of fixation, active or passive exercises of the injured joint are performed.
4) The healthy limbs and trunk should be maintained as much as possible for normal activities to improve the general condition and prevent the occurrence of comorbidities.
(3) Physiotherapy: role: to reduce swelling and pain, improve blood circulation, promote bone scab formation, reduce adhesions and soften scarring.
1)Ultrashort wave: the affected part is opposed, no heat within 1 week of fracture, micro heat after 1 week, 10-15min each time. can be performed outside the cast, but disabled when there is metal internal fixation.
2) Ultraviolet light: fracture localized, suberythematous amount or erythematous amount, 1 time per day or every other day, 3 to 5 times as a course of treatment. If the local cast is fixed, the corresponding part on the healthy side can be irradiated.
3)Magnetotherapy: choose pulsed electromagnetic therapy, the affected limb is located in the ring magnetic pole, or take the affected area opposite method, 20min each time, once a day, 20 times for a course.
4) Ultrasound: for patients with delayed fracture healing. Fracture local contact movement method, 0.5~1.0W/M2, 5~8min each time, once a day.
5) Paraffin wax therapy: applicable after fracture healing, disc wax method, temperature 42℃, 30min each time, 1～2 times a day. Following wax therapy, passive or active joint movement is performed, which is beneficial to the recovery of limb function.
6)Hydrotherapy: applicable to functional exercise in the late stage of fracture, water exercise or whirlpool bath can be chosen.
7) Massage: at the proximal end of the fracture site, massage is performed using centripetal techniques.
2. Fracture healing period (late stage) The purpose of treatment is to eliminate residual swelling, soften and stretch the fibrous tissue, increase the range of motion of the joint, enhance muscle strength and train muscle dexterity.
(1) Physical therapy: wax therapy, infrared, short-wave, and hot compresses promote blood circulation and improve joint range of motion; iodine ion introduction softens the scar and loosens adhesions.
(2) Massage: followed by heat therapy and focused on deep pushing and pressure to stretch the adhesion fibers and eliminate the residual swelling. Compared with the early stage, the treatment technique should be enhanced in the later stage, and the pain can be reduced by massage. Kneading and rubbing cause intramuscular movement and help to stretch the adhesions to obtain a greater range of motion.
(3) Motor exercise: Active exercise is initiated depending on the degree of scab formation and firm internal fixation.
1) Assisted exercise and passive exercise: when the limb is difficult to move independently at the beginning of cast removal, assisted exercise can be used, and assisted exercise can be reduced as the range of motion of the joint improves. For severe tissue contracture and adhesions, if active and assisted movements are not effective, passive stretching or joint release can be used, but the stretching should be smooth and gentle, and should not cause significant pain and swelling. Do not use violence to avoid causing new tissue damage.
2) Active motion: The affected joint should undergo active motion in the direction of each axis of activity. The amplitude of movement should be gradually increased, within the patient’s tolerance range, several times a day, for about 30 min each time.
3) Muscle strength and endurance exercises: When the muscle strength is level 1 (MMT), low-frequency pulse electrical stimulation, passive exercise and power-assisted exercise can be used. When the muscle strength is 2 to 3 levels, active exercise is the main, assisted exercise is supplemented. When doing power-assisted exercise, the power should be small to prevent passive exercise from replacing the active exercise of the patient’s independent practice. When muscle strength reaches level 4, resistance exercises should be performed to promote maximum recovery of muscle strength.
4) Application of braces and orthoses: The application of braces for closed fractures not only stabilizes the hand fracture site but also provides functional activity, which facilitates contact of the fracture section and promotes more bone scab production. However, prolonged stable braking of the upper and lower joints of the fracture site is harmful to bone healing. When joint contracture is severe, the affected limb can be immobilized with a brace or orthosis during the interval between treatments to reduce elastic retraction of fibrous tissue in order to maintain the therapeutic effect. As the ROM of the joint improves, the brace and orthosis should be adjusted accordingly.
5) Occupational therapy: According to the specific dysfunction of the patient after fracture, select some occupational therapy from daily life activities, manual labor and cultural and sports activities that can help the function and skill recovery of the affected limb.