In order to facilitate clinical rehabilitation, fracture rehabilitation is roughly divided into two stages: the fracture fixation period (early stage) and the fracture healing period (late stage).
I. Fracture fixation period (early stage)
Continuous swelling is the main cause of disability after fracture, and the early rehabilitation treatment focuses on eliminating swelling and controlling pain.
Elevation of the limb.
The distal end of the limb must be higher than the proximal end, and the proximal end should be higher than the heart level.
Active Exercise.
Active exercise is the most effective, feasible and least expensive method to eliminate edema fluid.
1. Active movement on each axis of motion of the upper extremity on the affected side of the unanchored joint, with assistance if necessary. Each time about 10 min, several times a day. Be careful to gradually increase the intensity of the activity so as not to affect the stability of the fracture end. The upper limb should pay attention to shoulder abduction, external rotation and hand function position.
2.When the fracture is basically stable and the soft tissues are basically healed, perform rhythmic isometric contraction exercises of the fixed muscles to prevent wasting muscle atrophy and to make the fracture ends fit together to facilitate bone healing. Each exercise should be performed for about 10 min, several times a day.
3. Intra-articular fractures should start functional exercises as early as possible, which can promote the repair and shaping of the articular cartilage surface and reduce intra-articular adhesions. Generally, after 2 to 3 weeks of fixation, active or passive exercises of the injured joint should be performed.
4. The healthy limbs and trunk should be maintained as normal as possible to improve the general condition and prevent the occurrence of comorbidities.
Physical therapy.
Effects: Reduce swelling and pain, improve blood circulation, promote bone scab formation, reduce adhesions and soften scarring.
1. Ultrashort wave.
Opposite the affected part, no heat within 1 week of fracture, micro heat after 1 week, 10-15min each time. can be performed outside the cast, but disabled when there is metal internal fixation.
2. Ultraviolet light.
Fracture localized, suberythematous amount or erythematous amount, 1 time per day or every other day, 3 to 5 times as a course of treatment. If local plaster fixation, can be irradiated in the corresponding part of the healthy side.
3.Magnetic therapy.
Choose pulsed electromagnetic therapy, the affected limb is located in the ring magnetic pole, or take the affected area opposite method, each time 20min, once a day, 20 times for a course of treatment.
4.Ultrasound.
Applicable to patients with delayed fracture healing. Fracture local contact movement method, 0.5~1.0W/M2, 5~8min each time, once a day.
5.Paraffin wax therapy.
Applicable after fracture healing, disc wax method, temperature 42℃, 30min each time, 1～2 times a day. Following wax therapy for passive or active joint movement, which is conducive to limb function recovery.
6. Hydrotherapy.
Applicable to functional exercise in the late stage of fracture, water exercise or whirlpool bath can be used.
7.Massage.
At the proximal end of the fracture site, massage is performed using centripetal techniques.
Fracture healing period (late)
The purpose of treatment is to eliminate residual swelling, soften and stretch the fibrous tissue, increase the range of motion of the joint, enhance muscle strength and train muscle dexterity.
Physical therapy.
Wax therapy, infrared ray, short wave, heat application to promote blood circulation and improve joint range of motion; iodine ion introduction to soften the scar and loosen the adhesions.
Massage.
Followed by heat therapy and focused on deep pushing and pressure to stretch the adherent fibers and eliminate residual swelling. The treatment technique should be enhanced in the later stages compared to the early stages, and pain can be reduced by massage. Kneading and rubbing cause intramuscular movement and help to stretch the adhesions to obtain a greater range of motion.
Exercise.
Depending on the degree of scab formation and secure internal fixation, active exercises are initiated.
1. Assisted and passive movements.
When the limb is difficult to move on its own at the beginning of cast removal, assisted movement can be used, and assisted movement can be reduced as the joint range of motion improves. For severe tissue contracture and adhesions, if active and assisted movements are not effective, passive stretching or joint release can be used, but the stretching should be smooth and gentle, and should not cause obvious pain and swelling. Do not use violence, so as not to cause new damage to the tissue.
2.Active movement.
Active movement of the involved joint in the direction of each axis of activity. The amplitude of movement should be gradually increased, within the patient’s tolerance range, several times a day, for about 30 minutes each time.
3.Muscle strength and endurance exercises.
When muscle strength is level 1 (MMT), low-frequency pulse electrical stimulation, passive exercise and power-assisted exercise can be used. When the muscle strength is 2 to 3 levels, active exercise is the main, assisted exercise is supplementary. When doing power-assisted exercise, the power should be small to prevent passive exercise from replacing the active exercise of the patient’s independent practice. When the muscle strength reaches level 4, resistance exercise should be performed to promote the maximum recovery of muscle strength.
Application of braces and orthoses.
The application of braces for closed fractures both stabilizes the fracture site of the hand and provides functional activity, which facilitates contact of the fracture section and promotes more bone scab production.
However, prolonged stabilization and braking of the upper and lower joints of the fracture site is detrimental to bone healing. When joint contracture is severe, the affected limb can be immobilized with a brace or orthosis during the interval between treatments to reduce elastic retraction of fibrous tissue in order to maintain the therapeutic effect. As joint ROM improves, the brace and orthosis should be adjusted accordingly.
Occupational therapy.
According to the specific dysfunction of the patient after fracture, some occupational therapy from daily life activities, manual labor and cultural and sports activities are selected to help the function and skill recovery of the affected limb.