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 presence of pain in the functional exercise, is inevitable, but always to the extent that the patient can tolerate.
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 on the healthy side at the same time. 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 painless 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 fever is obvious, you can 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.
The rehabilitation program changes depending on the type of fracture, the degree of fracture, the surgical technique and the fixation method.
Overall rehabilitation goals:
Joint mobility: to restore normal joint mobility of the hip, ankle and knee.
Muscle strength: to promote and improve the muscle strength of the lower extremities and to restore the standing stability mechanism of the lower extremities.
Functional goal: to achieve normal gait and return to normal living ability.
Pre-operative rehabilitation.
Elevation of the affected limb, ankle pump, edema control.
Strength training of upper limb and healthy lower limb (isotonic muscle tension training – anti-gravity, etc.).
Post-operative rehabilitation.
Rehabilitation contents.
Phase I: Maximum protection period
(1 day – 4 or 6 weeks)
Contraindication: If subrotor comminuted fracture, medial cortical reconstruction is required and active contraction of hip adduction and abduction muscles is delayed for 4-6 weeks to avoid stress at the fracture point.
Objective: prevention of postoperative complications, restoration of lower limb muscle strength, hip mobility (0°-80°,90°), restoration of patient control of the affected limb, independent walking with a walker
1-2 days.
Objective: to reduce pain, control swelling, release muscle spasm, prevent deep venous thrombosis and pulmonary complications, and restore the patient’s ability to transfer position. To achieve others to help get in and out of bed to enter the next small stage.
1. Educate the patient: inform the patient of the expected recovery time, instruct the patient to position the affected limb in a safe position and safe movement, paying special attention to contraindicated movements. Pay attention to the prevention of wound infection.
2.The affected limb elevation.
3.Ankle pump.
4.Deep breathing and cough training.
5.Ice packs on the hip
6.Gentle active-assisted hip abduction and adduction
7.Active or assisted-active or passive hip mobility training
8.Quadriceps femoris, N cord muscle, gluteus maximus submaximal strength isometric muscle contraction training.
9.Begin bed activities, lying-sitting position conversion
10.Muscle strength training of upper limb and healthy side limb.
11.Correct body position placement.
3-7 days
Objective: To walk independently with the assistance of a walker, etc. Achieve 1.getting in and out of bed independently; 2.walking 15 meters independently with the aid. Enter the next stage
1.Observe the patient’s function, increase bed activities, instruct the patient to sit up with less assistance and try to reach independent sitting up
2.According to the patient’s fracture and internal fixation, increase the activities out of bed with or without weight-bearing
3. Encourage the patient to exercise independently and help to overcome difficult movements
4.Start straight leg elevation of the affected limb in the standing position (anterior-posterior and lateral)
5.If it is a stable fracture, gentle Thomas distraction of the hip joint can be performed daily
6. Start sitting/standing in a straight-backed chair and adjust the number of times as tolerated by the patient
7. Start walking twice a day with assistive devices
2-6 weeks
Objective: To restore partial independence in daily activities. Orthopedic 6 weeks review of fracture healing well into the next phase.
1.Continue the previous training
2.Instruct the patient in home training, 20-30 minutes each time, 2 times a day
3.Stand or walk in, observe the patient’s posture, correct the posture
4.Strengthen the gluteus maximus strength, train the balance and proprioceptive training for standing and walking
Phase II: Medium protection period
6-8 weeks
Purpose: Proper protection of the fracture point, further restoration of muscle strength and daily activity ability.
1.Educate the patient
2.Progressive restoration of soft tissue and joint mobility
3.Increase resistance muscle strength training and improve joint stability
4.The affected limb can be partially weight-bearing or fully weight-bearing.
Stage 3: Minimal protection period
(8-12 weeks)
Purpose: Patients should achieve full ROM in hip, knee and ankle joints, if not, instruct patients to PROM and distraction
1.Instruct the patient to progressive resistance training of lower limbs to increase muscle strength
2.If the fracture heals well, instruct the patient to disengage the walker
Special considerations.
If the patient has a hip replacement, contraindicated actions are the same as hip replacement
Appendix:
1. Elevation of the affected limb: It is a method of using gravity to help blood and tissue fluid return to reduce swelling and relieve pain at the traumatic site. 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 the role of a pump 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 lying 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 pack for the hip: Our hospital has special ice packs. For 3 days after surgery, apply ice packs 4 times a day in the morning and afternoon for 10 minutes each time. After each functional training, each ice pack should be 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. It is required to move in the range that the patient can tolerate the pain.
6.Quadriceps femoris, N cord muscle, gluteus maximus submaximal strength isometric contraction training.
The above three groups of muscles are tensed without action within the pain-free range of the fracture point, tensed for 10 seconds, relaxed for 10 seconds, for one group, 10 groups of training each time.
7.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.
8, 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
9, correct body position: the affected limb is placed in a comfortable position, and there is no stress effect on the fracture point.
10.Start standing with the affected limb in straight leg raise: front and back
11.Thomas hip stretching: supine position with the affected limb on the bed and the knee joint of the healthy limb gently pulled to the chest to prevent stiffness of the back muscles.