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Abstract: A 42-year-old male patient was diagnosed with a comminuted fracture of the right upper tibiofibular segment after being hit by a heavy object on his right calf 20 hours ago, and recovered well after surgical treatment. However, 3 months after surgery, he still could not move down normally, and was diagnosed with muscle atrophy at the time of review, so the patient was hospitalized again for rehabilitation and functional exercise, and the patient gradually recovered his calf muscle strength and could gradually move out of bed.
Basic information】Male, 42 years old
Disease Type】Muscle Atrophy
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of consultation】June 2021
Treatment plan】Functional exercise (active exercise + passive exercise)
Treatment Period】1 month of hospitalization and regular follow up
Results】The patient recovered well in lower limb function, muscle atrophy was restored, and joint movement was good.
I. Initial consultation
The patient was injured by a heavy object on the right upper calf, and felt local pain, swelling, bleeding, numbness on the right outer calf, no dizziness, impaired consciousness, no chest tightness, shortness of breath, no abdominal distension, abdominal pain and other discomfort. The patient came to our hospital for further treatment. After admission, the CT 3D reconstruction of the right tibiofibula was perfected, which showed that the patient had an open tibiofibular fracture on the right side, so the patient was given surgical treatment. The patient was discharged from the hospital. Within 3 months after discharge, the patient was free from weight-bearing functional exercise, and was diagnosed with muscle atrophy when he was re-examined 3 months later.
II. Treatment process
The patient was treated mainly with functional exercise, i.e. active exercise of the calf with passive exercise, active exercise such as kicking, leg flexion, calf muscle stretching, etc. can increase calf muscle endurance; passive exercise such as manual massage, hot compress, physiotherapy, etc. can help relieve muscle fatigue and further improve muscle strength. Patients are advised to restrict blood flow through bandages during functional exercise, which will have better effect.
III. Treatment effect
After about 1 month of functional exercise, the patient’s muscle atrophy recovered, and the strength of the patient’s muscles recovered to level 5. The patient and his family were very satisfied with the treatment effect.
IV. Notes
We are glad that the patient’s muscle atrophy was corrected, but we need to advise the patient to avoid weight-bearing training and strenuous exercise of the lower extremities until they are fully improved, pay attention to the combination of work and rest, and massage after each exercise to avoid muscle fatigue, which may cause muscle soreness or fail to achieve the expected effect. Diet is recommended to be high in protein and nutrition, which helps to promote muscle strength recovery.
In addition, it is necessary to review the vascular ultrasound of the lower limbs regularly to observe the vascular condition and seek medical consultation at any time if there is any condition.
V. Personal insight
After active treatment, the patient’s nerve, vascular and skeletal injuries healed, but because of the long-term inability to move on the ground, muscle atrophy inevitably occurred, resulting in a decrease in muscle strength. For this kind of patients, there are often some contradictions in the treatment. At this time, according to the severity of the disease, priority should be given to the treatment of important injuries, and rehabilitation exercises should be carried out slowly at a later stage, which can effectively reduce the occurrence of functional disorders in the later stage of the patient.