Fracture healing and functional exercise
The treatment of fracture is different from the treatment of other diseases, and its prominent feature is that the treatment period is long. Long time bed rest, traction, internal fixation of local plates and pins, external fixation of plaster and splint, and long time braking of limbs make the joints adjacent to the fracture inactive for a long time, which greatly affects the local blood and lymphatic circulation and leads to osteoporosis, adhesion and contracture of the soft tissues around the joints, and muscle wasting atrophy, resulting in functional impairment such as stiffness or straightness of the joints, limb bending and strength. Muscle wasting atrophy causes stiffness or straightness of the affected limb, limb bending, weakness and other dysfunctions. If the correct and timely functional exercise is not provided, the limb dysfunction will not be restored and will become a permanent disability. So, what is functional exercise? In the bone and joint injury, in addition to the doctor’s treatment, the patients themselves exercise, massage, stretch the muscles, move the joints to restore the normal activities of the limbs is called functional exercise.
(1) The purpose of functional exercise is to restore the inherent functions of the joints of the trunk and limbs, and to prevent various changes that are detrimental to joint activities, such as joint contracture, ligament shortening, muscle stiffness, and synovial adhesions due to bleeding. Even if there is hematoma, edema and mechanization around the joint, the scar can be relaxed and softened through activities, which will no longer affect the joint activities, so functional exercises should be carried out as early as possible.
(2) Method of functional exercise: We should emphasize the autonomous functional exercise, which should be performed repeatedly and uninterruptedly, and the exercise should be gradual, patient and meticulous. The range of activities should be from small to large, slow to fast speed, the number of times from little to more, do not take rough passive activities. In the exercise to injury sites such as fractures, dislocations, soft tissue fractures do not occur pain, swelling as the principle.
(3) Functional exercise requirements: to achieve the purpose of restoring the original physiological function of the limb. The upper limb requires flexibility and mobility to restore function, and the lower limb requires firmness and stability to restore weight-bearing and walking.
Why should functional exercise be performed after fracture fixation?
The principle of fracture treatment is “reset, fixation, functional exercise”. Various forms of functional exercise can help patients reduce complications, heal smoothly and resume work and life as soon as possible. Some people use “three points of treatment, seven points of exercise” to describe functional exercise. So what is the significance of functional exercise?
(1) Promote swelling and prevent joint adhesions and stiffness: After fracture, the soft tissues at the fracture site will have varying degrees of bleeding and edema, making the venous and lymphatic flow obstructed, thus resulting in swelling of the injured limb, which, if not eliminated in time, can lead to adhesions and even stiffness of the corresponding soft tissues. Such adhesions can occur in the muscles and tendons, between the tendons and synovial membranes, and in the joints, thus affecting muscle contraction and joint movement, resulting in stiff adhesions and impaired movement of the joints. Through functional exercises of active muscle contraction, venous and lymphatic return is promoted, hematoma absorption is facilitated, swelling subsides, and joint fluid leakage is reduced. This prevents joint stiffness caused by adhesions of the joint itself and soft tissues.
(2) Promote fracture healing: Repeated muscle stretching and contraction of the injured limb can strengthen the longitudinal compression of the fracture, make the fracture gap smaller and the fracture part more stable, which can improve the nutrition of the fracture part and enhance the bone capacity of the fracture end to promote fracture healing. Functional exercises can also correct minor fracture misalignment, which is also beneficial to the healing of fracture.
(3) Promote blood circulation: functional exercises can promote blood circulation and prevent thrombosis. Due to the damage of the traumatic blood vessel wall itself, the blood will easily form blood clots when it flows slowly in the damaged blood vessels, which is called “thrombus”. Small thrombus can dissolve by itself, but if the thrombus is larger, it will come off from the blood vessel wall and enter into the systemic circulation with the blood, which may cause infarction of heart, brain and lung important organs, and may cause sudden death of the patient in serious cases.
(4) Reduce complications: Regular activity and exercise can prevent bone, joint and muscle complications, such as osteoporosis, delayed fracture healing, joint adhesions, joint capsule contracture, joint stiffness and muscle atrophy and many other complications.
In order for patients to overcome their injuries and recover the maximum range of body functions, the best therapeutic effect can only be achieved by insisting on scientific functional exercises under the guidance of medical personnel.
When to perform functional exercises for fracture patients?
Reasonable functional exercise not only enables the patient to get rid of the pathological psychology as soon as possible and build up self-confidence in overcoming the injury, but also promotes blood circulation throughout the body and locally, improves the nutritional status of tissues, accelerates the healing time of the injury, and strengthens the recovery of physical ability and strength to adapt to the needs of future life and work.
Orthopedic patients in functional exercise generally for three stages, namely early, medium and late. The focus of exercise at each of the three times.
(1) Early exercise: Early exercise refers to the patient within 2 weeks after the injury. At this stage, the injured limb generally has obvious swelling, pain and other symptoms. Although the fracture end is reset but not healed, very unstable, easy to regenerate displacement. At this time, the exercise should focus on muscle exercise. The specific approach is to actively carry out muscle contraction and diastole under the condition of joint activity. The exercise of the upper limb muscles is to clench the fist and fully flex and stretch the fingers, repeatedly alternating, the exercise of the lower limb muscles is to contract and relax the quadriceps, force the ankle plantar flexion, dorsiflexion and extension and flexion activities toes, early exercise can promote the injured limb swelling.
(2) Mid-term exercise: The mid-term exercise refers to 3~6 weeks after the patient’s injury. At this stage, the swelling of the injured limb gradually disappears, the bone scab at the fracture site has gradually formed or matured, and the fracture end has become more stable and close to clinical healing. During this period, you should start to do large joint activities to gradually restore the function of the limb under the premise of continuing muscle exercise. However, it should be especially reminded that joint activities should not be too strenuous and too rough, and at the same time, various activities that are not conducive to fracture connection and stability should be restricted.
(3) Late stage exercise: The so-called late stage refers to the patient’s fracture has reached clinical healing, the external fixation has generally been removed, and the range of joint movement has gradually returned to normal. At this stage, the bead function of the body is exercised. For the muscles and joints that still have different degrees of dysfunction, targeted exercises should be carried out.
How to carry out functional exercise for fracture patients?
After the fracture patient is reset and fixed, it is important to maintain relative stability, which is conducive to fracture healing and repair. In the process of fracture repair, the only way to promote fracture repair is to make the expansion joint move appropriately and to take functional exercises in combination with motion. How to carry out functional exercise for fracture patients? Functional exercise can be divided into two kinds of active exercise and passive exercise. Active exercise: In the process of exercise, the subjective initiative of the fracture patient is given priority to his own exercise. For example, after fixation of humeral stem fracture of upper limb, functional exercise should start from finger extension and flexion and fist clenching activities, gradually strengthen the muscle contraction, and after two weeks, carry out the activities of upper and lower joints. Be careful not to let the forearm sway from side to side and droop excessively to prevent fracture displacement and bone disjunction. Passive exercise: It means that the fracture patient cannot effectively perform active exercise by himself after fixation, and must be helped by medical personnel or relatives to perform functional exercise. If the joint stiffness is caused by spinal cord or peripheral nerve injury, long-term improper external fixation or the patient is afraid of pain, passive functional exercises can be performed, such as massage, extension and flexion of the joint, with gentle movements, avoiding roughness to avoid soft tissue lacerations or ossifying myositis, which may affect the recovery of function.
The method of exercise can be divided into weight-bearing and non-weight-bearing exercise. Non-weight-bearing exercises are generally used before the clinical healing of the fracture, such as finger (toe) extension and flexion. Weight-bearing exercises are performed after the fracture has healed clinically, such as pinching and holding objects in the upper extremity and walking with weight in the lower extremity. Some fractures can be performed under the protection of external fixation, such as tibiofibular fracture of the lower leg, after the external fixation frame is fixed, you can walk on the ground to exercise, which is beneficial to the healing of the fracture.
What issues should be noted in functional exercise?
The functional exercise of orthopedic patients is a very important part of the treatment work, so it is different from the sports activities in daily life and cannot be done according to personal interests. It requires scientific guidance, strict management, thorough arrangement and careful implementation to achieve the desired effect and achieve the expected therapeutic purpose. Therefore, the following issues should be noted when performing functional exercises.
(1) Functional exercise should be carried out under the guidance of medical personnel, and a long-term scientific exercise plan should be formulated according to the patient’s degree of injury, physical quality, treatment method and different stages of injury.
(2) Functional exercise should be started after the fracture is repositioned and fixed until the fracture heals and function is restored to the maximum extent. In the process of treatment and rehabilitation of orthopedic injuries, functional exercise will be carried out throughout and should be a continuous process. Therefore, patients should be prepared to adhere to the long-term thinking, not to fish for three days and sunbathe for two days. Functional exercise is not entertainment, it is monotonous and boring, and sometimes have to endure pain, if there is no strong will and perseverance, will not achieve satisfactory results.
(3) Functional exercise is mainly active exercises, supplemented by passive exercises. Appropriate passive exercises can increase the mobility of joints, but only active exercises can prevent muscle atrophy, restore muscle tone and increase the mobility of joints. Exercise should be gradual, and the intensity, amount and duration of exercise should be tailored to the disease and the individual. Repeated strong passive joint activities must be strictly forbidden, otherwise it will not only be unhelpful, but also cause ossification around the joint and loss of movement.
(4) It is necessary to strengthen the functional exercises of the key joints, but not to neglect the adjacent joints. For intercondylar fracture of the humerus, although strengthening the functional exercises of the elbow joint is the main one, the functional exercises of the shoulder joint, wrist and hand joints should not be neglected.
(5) Pay attention to the patient’s body reaction after exercise, find out the problem in time, and revise the exercise plan and adjust the amount of exercise at any time to get the best effect.