Caution.
1.The methods and data provided in this plan are developed in accordance with the general routine, and the specific implementation needs to be completed under the guidance of the doctor depending on their own conditions and surgical situations.
2.The pain that exists in the functional exercise is inevitable, but always tolerated by the patient. Lv Haisheng, Department of Orthopedics, Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine
3, muscle strength exercises should focus on the target muscles. The number of exercises, time, and conformity depend on their own situation, and should be practiced at the same time the healthy side. The improvement of muscle strength is the key factor of joint stability and must be practiced carefully.
4.In addition to the surgical limb training, the rest of the body parts (such as upper limbs, waist and abdomen, healthy side of the leg) should be practiced as much as possible to ensure physical quality and promote the overall recovery of body function.
5.Early joint mobility exercises, daily adhere to complete the training, as far as possible early pain-free and resistance-free recovery of larger angles, internal fixation instability need to protect the specific situation specific analysis.
6.Ice packs should be applied for 15-30 minutes immediately after the mobility exercise. If you usually feel the joint swelling, pain and heat is obvious, you can apply ice again, 2-3 times a day.
7, joint swelling will accompany the entire exercise process, swelling does not increase with the angle of the exercise and the amount of activity that is normal, until the angle and muscle strength is basically back to normal swelling will gradually subside. Sudden increase of swelling should adjust the exercise, reduce the amount of activity, and in serious cases should be timely follow-up.
8. See appendix for training methods.
Rehabilitation program changes depending on the type of fracture, degree of fracture, surgical technique and fixation method
Overall rehabilitation goals:
Joint mobility: restore knee joint at least (0°, 110°), ankle joint (10°, 20°)
Muscle strength: improve dorsiflexion, plantar flexion, pronation and valgus muscle strength
Gait: restore normal gait
Preoperative rehabilitation.
Traction elevation of the affected limb, ankle pump, edema control.
Isotonic muscle tension training of upper limb and healthy limb – anti-gravity, etc.
Post-operative rehabilitation.
3 months postoperative weightless tibial stem high-energy comminuted fracture, gait: 2-point gait
Ground energy stable fractures of the tibial trunk can be painful and tolerate lower partial weight-bearing in the early postoperative period.
Postoperative rehabilitation of externally fixed fractures is handled according to the surgeon’s opinion.
Phase I: Maximum protection period
1-2 days after surgery
Contraindication: avoid standing rotation of the affected limb
Purpose: To reduce pain, control swelling, prevent deep venous thrombosis, prevent reflex muscle inhibition, avoid adhesions and muscle atrophy. If the pain and swelling are controlled, you can move to the next small stage.
Rehabilitation content.
1. Elevation of the affected limb above the heart.
2.Ankle pump.
3.Deep breathing and coughing exercises.
4.Ice packs on the lower leg
5.Active joint mobility training of knee and ankle joint
6.Quadriceps femoris, N cord muscle, gluteus maximus and other long muscle strength contraction training.
8.Tibialis anterior, triceps submaximal isometric muscle strength training.
9.Correct body position placement.
10.Sit up and stand up in bed.
11.Strength training of upper limb and healthy side limb.
3 days-6 weeks after surgery
Goal: Good transfer ability and balance, return to normal ROM of knee and ankle joint.
Contraindication: Avoid standing rotation of the affected limb.
Rehabilitation content.
1.Continue the content of phase 1 and start the end-end muscle strength training of the knee joint .
2.If the patient remains bedridden, continue upper extremity and healthy side muscle strength training.
3.Instruct the patient in bed-standing-chair transfer training.
4.Walking training under the aid.
Phase II: Moderate protection period
6 weeks-3 months after surgery
Objective: To protect the fracture point and further restore muscle strength. The fracture point is stabilized to enter the next stage.
1. If the patient’s ankle and knee joints have not reached normal, start passive joint mobility training
2.Start gentle progressive resistance muscle strength training for quadriceps and metatarsal dorsiflexors.
3.Stable fracture start closed chain training.
4.Stable fractures begin to tolerate lower partial weight-bearing; unstable fractures continue without weight-bearing.
Stage 3: Minimal protection period
(3-6 months)
Objective: Gradually disengage from the walker and resume functional activities.
1.Tolerate weight-bearing with the assistance of a walker, gradually switch to a cane, and then gradually walk independently.
2. Gradually resume sensitive activities and return to tolerate non-impact physical activities.
Stage 4
>6 months
1. Orthopedic management if there are signs of non-union or delayed healing of the fracture.
Appendix:
1. Elevation of the affected limb: It is a method of using gravity to help blood and tissue fluid return to reduce swelling at the trauma site and relieve pain. As much as possible, the injured part is placed above the level of the heart to use gravity to help blood return to the heart. Post-operative swelling is recommended to do this action.
2. Ankle pump: extreme dorsal extension of the ankle joint, hold for 10 seconds, relax and rest for 10 seconds, then extreme plantar flexion, hold for 10 seconds, then relax for 10 seconds, and so on in a cycle of 10 as a group.
The movement of the ankle joint plays a pump-like role to promote blood circulation and lymphatic flow in the lower limbs and reduce swelling. You can do it often after surgery.
3. Deep breathing and coughing training. In the prone or sitting position, instruct the patient to breathe deeply in the abdomen; cough training in the sitting position to expel the phlegm as much as possible and keep the airway open.
4.Ice the fractured femoral stem: Our hospital has special ice packs. For 3 days after surgery, ice was applied 4 times a day in the morning and afternoon for 10 minutes each time. After each functional training, each ice pack is applied once for 15 minutes each time.
The main principles of icing are.
1. constrict the blood vessels at the injured area to reduce bleeding, thus reducing swelling.
2.To relieve pain.
3, relief of muscle spasm.
4.Reducing the risk of cellular tissue damage by decreasing the metabolic rate.
5.Active or assisted-active or passive hip mobility training: It is best if the patient can do it actively, if the patient is not able to do it actively, it can be done with the help of the therapist or passively. Ask the patient to move within the range of pain tolerated by the patient.
6.Guide the patient to walk under the walker and observe the gait to guide the patient. crutches are recommended for patients under 60 years old and still physically fit, and walkers are recommended for patients over 60 years old and physically weak.
7. Open-chain and closed-chain training.
Open chain: refers to the movement of the proximal end of the limb fixed while the distal joint moves
Closed chain: the movement of the distal end of the limb fixed while the proximal joint is moving
8.Quadriceps femoris, N cord muscle, gluteus maximus muscle sub-maximal strength isometric contraction training.
The above three groups of muscles in the painless range of the fracture point without action tense, tense for 10 seconds, relax for 10 seconds, for a group, each training 10 groups
9.Start bed activities, lying-sitting conversion: let the patient do it independently or with assistance as early as possible after the anesthesia period, if dizziness, let him/her lie down slowly; repeat lying-sitting-lying position to prevent postural hypotension.
10, upper limb strength exercise and healthy side muscle strength exercise: hold each force for 10 seconds, come down slowly, rest for 10 seconds, 10 consecutive movements as a group, 10 groups each time
11. Correct body position: the affected limb is placed in a comfortable position, and there is no stress effect on the fracture point.
2-point gait: the affected limb and crutches to do a unit, the healthy side of the lower limb to do another unit, walking, the affected limb can be partially weight-bearing can be non-weight-bearing.