Reconstruction, fixation and functional exercise are the three basic steps in the treatment of fractures. However, there are long-standing differences between TCM and Western medicine on how to recover, how to fix and when to move. The focus of the debate is on how to deal with the four contradictions in fracture treatment: fixation and movement; bone marrow and soft tissue; local and overall; medical measures and patient’s subjective initiative.
In ancient times, Chinese medicine was not combined with modern science and for the application of modern technical achievements, it mainly relied on human inherent sense organs and human instincts to diagnose and treat by looking, smelling, feeling and comparing measurements. The fracture was repaired by manipulation, splinted locally, excluding the upper and lower joints, and the patient was encouraged to move early, thus implementing the principle of combining motion and static treatment. However, for some fractures that are difficult to rectify and not easily fixed, poor alignment often results in deformed healing and affects the shape and function of the limb.
The treatment principles of Ge’s orthopedic treatment are
I. Overall concept
We should not simply pay attention to the local situation of the fracture, but should pay attention to the whole body of the injured person in a timely manner, as each part of the fracture and the form of the fracture are different. Each has its own characteristics.
Early revision
In principle, it is necessary to strive for a satisfactory repositioning this morning, preferably within 1-4 hours after the injury, when the local swelling is not serious, which facilitates the manipulation and helps to promote the rapid healing of the fracture, especially in children, because the fracture heals quickly and requires early repositioning. Generally, you should not wait for the swelling to subside, otherwise it is not easy to achieve satisfactory results. Before repairing, rub the muscles and tendons of the injured limb to promote blood circulation, then squeeze the swollen area, the force of the technique should be gentle, even and long-lasting, the ending swelling can be reduced, which is conducive to the manual repair.
Three, tendon and bone treatment
When a fracture is sustained, the tendons, muscles and other soft tissues must be injured. Therefore, when treating a fracture, the tendons and bones must be treated together. For example, when fixing a fracture, the tendons and bones should be divided and regulated to promote the smooth flow of Qi and blood, which will facilitate the dissipation and absorption of the blood and the recovery of the fracture, and when adjusting the fixed splint, the tendons and bones should also be adjusted and regulated, and even in the process of fixation, the tendons and joints at both ends should be moved. This treatment of tendons and bones can reduce the pain of the injured, shorten the course of treatment, and recover the joint function quickly.
IV. Alignment and alignment
After the fracture has been repaired and the various displacements have been corrected, that is, when the alignment and alignment are completely good, it is called anatomical fracture repositioning. This is the most beneficial to the healing of the fracture and the recovery of function. For some fractures where anatomic alignment cannot be achieved, it is sufficient to achieve functional recovery after fracture healing depending on the age, occupation, time and location of the fracture. It is called functional repositioning.
The criteria for functional repositioning of fresh fractures are.
1. Rotational displacement and separation displacement of the fracture part must be completely corrected.
2. Angular displacement of the diaphyseal fracture must be basically corrected, i.e., the alignment is basically good.
3.The lateral displacement of the diaphyseal fracture is more than one-third after rectification, and the lateral displacement of the epiphysis is more than three-quarters after rectification.
V. Combination of motion and static
The unity of fixation and activity after fracture correction. The fracture needs to be fixed after alignment, and the muscle tendon and other tissues need to be active, emphasizing fixation, which affects activity; emphasizing activity, which hinders fixation. Therefore, the two must be organically combined and unified. The fracture should be healed early and the muscle tendon should be restored to function as soon as possible. Fixation and activity are relative, not absolute. The fracture in fixation should be relatively stable, while the other parts should have the necessary activities; the active joints should be relatively active, but also need to have the necessary restrictions. Generally, in the early stage of fixation, static is the main focus, and in the late stage of fixation, movement is the main focus. A lot of practice has proved that this principle is the key to promote healing, shorten the healing process, and restore function early.
VI. Functional exercise
The human limb is developed in human activities, and it is used to prosper, but not used. If the fracture is fixed for a few weeks, emphasizing the static and neglecting the dynamic, the fracture will heal well, but the function of the injured limb will be muscle atrophy and joint ankylosis due to long time immobility, and still lose the active function, therefore, emphasizing the combination of dynamic and static, some necessary active and passive functional exercises should be carried out early, after the fracture is fixed, the active muscle contraction should be exercised, and without affecting the fracture fixation. All active joints should be subjected to necessary activities and functional exercises. The unreasonable super-joint fixation should be abolished during the fixation, and the functional exercise should be performed gradually. Starting from the active contraction of the muscles to the activity of the joint, the exercise must be carried out under the guidance of the doctor.
Seven, pinch tendon patting
Fracture reset to achieve clinical healing, you can remove the fixation, normal activities and exercises, plus pinch tendon patting, more conducive to dredge meridians, run qi and blood, strengthen blood circulation, conducive to bone stasis transformation shaping, promote the normal kinetic recovery. The pinching and tapping techniques are light and heavy, which is conducive to the adaptation process of the body.
The treatment principles of “Ge’s Orthopedics” can be summarized as follows.
Bone is the frame of tendon, tendon is the armor of bone.
Bone is the frame of tendon, tendon is the armor of bone, bone is broken, tendon is broken, bone is not connected.
Bone is the frame of tendon, tendon is the armor of bone.
Rub the injury in four places, the bruises will dissipate.
The bruises will be dispersed and the bones will grow, and the tendons and bones will be strong together.
Fixed is fixed, it must be combined with movement.
Flexion, extension and rotation, active and passive refinement.
Pinching and tapping, the tendons and bones will be rejuvenated.