In order to facilitate clinical rehabilitation, fracture rehabilitation is roughly divided into two stages: the fracture fixation period (early stage) and the fracture healing period (late stage).
I. Fracture fixation period (early stage)
Continuous swelling is the main cause of disability after fracture, so the 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 abduction, external rotation and functional hand 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 should be performed.
(4) The healthy limbs and trunk should be maintained as normal as possible to improve the general condition and prevent the occurrence of comorbidities.
3.Physiotherapy
Effects: Reduce swelling and pain, improve blood circulation, promote bone scab formation, reduce adhesions and soften scarring.
(1) Ultrashort wave
The affected part is placed opposite, no heat within 1 week of the fracture, micro heat after 1 week, 10-15min each time. can be done outside the cast, but it is prohibited when there is metal internal fixation.
(2) Ultraviolet light
Localized fracture, suberythematous amount or erythematous amount, 1 time per day or every other day, 3 to 5 times for 1 course. If the local cast is fixed, the corresponding part of 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, each time 20min, once a day, 20 times for a course of treatment.
(4) Ultrasound
Applicable to patients with delayed fracture healing. Fracture local contact movement method, 0.5～1.0W/㎝2, 5～8min each time, 1 time per day.
(5) Paraffin therapy
Applicable after fracture healing, disc wax method, temperature 42℃, each time 30min, 1～2 times a day. Following wax therapy, passive or active movement of the joint is performed to facilitate the recovery of limb function.
(6) Hydrotherapy
Applicable to the functional exercise of late 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)
The purpose of treatment is to eliminate the residual swelling, soften and stretch the fibrous tissue, increase the range of motion of the joint, strengthen the muscle strength and train the muscle dexterity.
1.Physical therapy
Wax therapy, infrared ray, short wave, hot compress to promote blood circulation and improve joint range of motion; iodine ion introduction to soften the scar and loosen the adhesions.
2.Massage
Following the heat therapy, deep pushing and pressure are emphasized 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 stretch the adhesions to obtain a greater range of motion.
3.Exercise
Active exercise is started according to the degree of scab formation and firm internal fixation.
(1) Assisted movement and passive movement
When the limb is difficult to move on its own at the beginning of cast removal, assisted movement can be used, and assisted movement 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, so as not to cause new damage to the tissue.
(2) Active movement
Active movement of the affected joint in the direction of each axis of activity. The amplitude of movement should be gradually increased and within the patient’s tolerance range, several times a day for about 30 minutes 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 method, supplemented by power-assisted exercise. 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 the muscle strength reaches level 4, resistance exercise should be performed to promote the maximum recovery of muscle strength.
(4) Application of braces and orthoses
The application of braces for closed fractures not only stabilizes the fracture site of the hand, but also provides functional activities that facilitate the contact of the fracture section and promote more bone scab production. However, prolonged stabilization and 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 the fracture, select some occupational therapy from activities of daily living, manual labor and cultural and sports activities that can help restore the function and skills of the affected limb.