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, so rehabilitation care plays a pivotal role in the treatment of fracture patients. Rehabilitation care can effectively improve and promote blood circulation, eliminate swelling, accelerate fracture healing, and avoid tissue adhesions, scar formation, muscle atrophy, joint stiffness, etc.
1.Phase I rehabilitation (1-2 weeks after injury)
At this time, the injured limb is swollen, painful, and the fracture end is unstable and easily re-displaced. Therefore, the main purpose of functional exercise can be mainly muscle exercise. In the early stage of fracture, the main goal is to maintain muscle tone and reduce local swelling, prevent joint stiffness and muscle atrophy, and combine fracture healing with functional recovery. Early bed rest, placing the affected limb in a comfortable position and keeping it slightly above the level of the heart, can promote venous return and provide centripetal massage to facilitate the swelling to subside.
Perform isometric contraction of the quadriceps muscle of the injured limb, that is, under the premise that the joint does not move, the muscle does rhythmic contraction and relaxation, that is, what we usually call tensing and loosening, through the isometric contraction of the muscle can prevent muscle atrophy or adhesion.
This is done 4 to 5 times a day for about 5 minutes each time, in order not to make the patient feel tired in the leg. Combined with active dorsiflexion and plantar flexion of the affected ankle joint, the above exercises should not interfere with the fixation of the fracture, not to mention activities that are not conducive to the healing of the fracture, especially not the internal and external rotation of the lower limb. During this period of rehabilitation, in principle, except for the upper and lower joints outside the fracture, all other parts of the body should be engaged in normal activities. Surgical patients should perform active and passive joint exercises 4-6 hours after surgery, and gently massage the muscles of the affected limb outside the wound to promote venous reflux in the affected limb and accelerate the decreasing of swelling.
To prevent the occurrence of deep vein thrombosis, patients are encouraged to breathe deeply and cough effectively, while the upper limb is abducted to expand the chest to enhance physical strength and cardiopulmonary function. At the same time, ankle and interphalangeal joint flexion and extension activities were performed, with isometric contraction of the calf muscles and quadriceps as the main activities. One to two weeks after surgery, patients were mainly helped to do muscle contraction and relaxation on their own. After the operation, closely observe the blood flow and activities of the affected limb, the blood leakage from the wound, the degree of swelling of the injured limb and the arterial condition of the injured limb; for hip fracture, the turning and activities of the affected limb within a few days after the operation are guided and assisted by medical personnel.
2.Phase II rehabilitation (2-4 weeks after the injury)
During this period, the injury of bone, joint, muscle, ligament and other tissues and surgical incision are healing, the pain and swelling of the surgical site are obviously relieved or disappeared, the fracture end has fiber connection and is forming bone scab.
During this period, joint activities can be carried out, and patients should be instructed to move the affected limb in bed without weight, to carry out active extension exercises of the knee, ankle and small joints of the foot, internal and external extension exercises of the ankle joint, isometric contraction of the quadriceps muscle, to use the traction bed to carry out upper arm exercises and train arm strength in order to use the crutches when going down, and to increase hip extension activities. For patients who have been in preoperative traction or cast for a long time and have a certain degree of joint stiffness, CPM exercises should be given, and then gradually over to active functional exercises of the joint. Gradually increase the intensity and range of activities, so that the whole body joints reach or approach normal activities, so that most of the function of the affected limb can be restored. However, activities still need to be restricted in this period.
3.Third phase rehabilitation (5-6 weeks after injury)
This period should exercise the joints and muscles, expand the range of motion of the joints in all directions, restore muscle strength and increase the motor function of the limb. During this period, continue to strengthen the active training of the joints of the affected limb, so that the function of the affected limb can return to the normal range of motion, and according to the situation of the fracture, can support the double crutches to get out of bed, especially to move the affected knee and hip, but the injured limb is strictly prohibited to bear weight.
4.Four-stage rehabilitation
The late stage of rehabilitation refers to the period from the healing of bone and joint tissues to the restoration of normal functions of the whole body and local area. The purpose of rehabilitation in this period is to restore the joint mobility of the affected joints, strengthen the muscles, and restore the function of the limbs.
The number, duration and intensity of training are higher than those in the early stage, so that the joints can quickly recover to the normal range of motion and the normal strength of the limbs, and the joints and muscles that still have different degrees of impairment are given targeted training, and equipment is used to strengthen the activities and do equipment exercises or Hand exercises, with physical therapy, massage, acupuncture, etc., so that limb function can be restored.
5.Psychological rehabilitation
A good psychological quality is a necessary condition for fracture rehabilitation. A lot of practice proves that maintaining an open and optimistic mood and establishing good self-confidence can reduce the physical discomfort caused by fracture and rehabilitation exercises; on the contrary, worrying and overthinking will aggravate the physical discomfort, reduce the resistance and prolong the recovery time. At the same time, establishing a good nurse-patient relationship will gain the patient’s trust and prevent the situation of passivity, dependency psychology and inactive cooperation with treatment and care. In response to the patient’s state of mind, actively guide him/her to be confident in recovery and inspire him/her to overcome difficulties, so that he/she can actively cooperate and strengthen functional exercise.
6. Dietary guidance
The rehabilitation process after fracture also requires various nutrients, including protein, vitamins, calcium, etc. It is very beneficial to drink bone broth, milk, and eat fresh vegetables, fruits, meat, and soy products appropriately, while asking patients to quit smoking.
7.Out-of-hospital rehabilitation
Explain the methods of functional exercise to discharged patients and their families, and write down various rehabilitation knowledge and precautions in a card to patients, and follow up with them by telephone every week. They are instructed to make regular outpatient reviews to ensure the continuity and effectiveness of rehabilitation exercises. In conclusion, the purpose of rehabilitation care is to promote the recovery of body function after fracture and prevent complications through targeted training. The implementation principle of rehabilitation care is gradual, active-oriented and passive-assisted.