How should rehabilitation be carried out after fracture surgery?

       Rehabilitation training after fracture can generally be divided into three phases: early phase of rehabilitation training This phase is one to two weeks after the injury, when the injured limb is swollen, painful, unstable and easily re-displaced. Therefore, the main purpose of functional exercise in this period is to promote the blood circulation of the affected limb to facilitate the reduction of swelling and stabilization of the fracture. The main form of rehabilitation training is the isometric contraction of the injured limb muscles, i.e., under the premise of joint immobility, the muscles do rhythmic static contraction and relaxation, i.e., what we usually call tensing and loosening, through which the isometric contraction of muscles can prevent muscle atrophy or adhesion. During this period of rehabilitation training, in principle, except for the upper and lower joints of the fracture area do not move, all other parts of the body should carry out normal activities.   The swelling of the injured limb gradually decreases, the pain decreases, the fracture ends have fiber connections and gradually form scabs, and the fracture site becomes more and more stable. During this period, in addition to continuing muscle contraction training of the injured limb, the movement of the proximal and distal unfixed joints and the upper and lower joints of the fracture can be gradually restored with the help of the rehabilitation therapist, and gradually change from passive to active activities to prevent the decrease of joint mobility of the adjacent joints. When the condition permits, the patient should get up as soon as possible to perform full body activities. In addition, physical therapy can be used to reduce swelling, remove blood stasis and promote the formation of bone scabs.  Five to six weeks after the injury, the fracture has sufficient bone scab formation to further expand the range of motion and strength, gradually increase active joint flexion and extension activities from one joint to several joints, prevent muscle atrophy, and avoid joint stiffness. Fractures involving the articular surface often leave significant joint dysfunction; therefore, it is best to start non-weight-bearing active motion of the articular surface about 2 weeks after fixation, and then to fix it afterward. In this way, the mutual compression and friction between the articular cartilage surfaces can promote the repair of the articular cartilage and make it better shaped, and at the same time, can prevent the formation of intra-articular adhesions.  At the later stage of rehabilitation training, clinical healing has been achieved or external fixation has been removed, at this time, bony scabs have been formed, X-ray examination has been revealed, the bones have a certain degree of support, but most of the adjacent joints have decreased joint mobility, muscle atrophy and other dysfunctions. The purpose of rehabilitation at this stage is to restore joint mobility and muscle strength of the affected joints, so that the limb function can be restored. The main form of rehabilitation training is active movement and weight-bearing exercises of the injured limb joints, so that the joints can quickly return to normal range of motion and normal strength of the limbs. The rehabilitation period can be accompanied by physical therapy and gait training.  The ultimate goal of fracture treatment is to restore the earliest and maximum function of the patient, and any surgery can never be the whole treatment. Rehabilitation care can effectively improve and promote blood circulation, eliminate swelling, accelerate fracture healing, avoid tissue adhesions, scar formation, muscle atrophy, joint stiffness, etc. Through nursing interventions, rehabilitation training is implemented throughout the patient’s illness, and planned rehabilitation care is provided to patients during hospitalization and out of hospital to promote fracture recovery and improve the quality of life.