I. Notes: 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 a doctor depending on your own conditions and surgical conditions. 2. The presence of pain in functional exercises is unavoidable. If the pain can subside to the original level within half an hour after the exercise is stopped, it will not cause damage to the tissue and should be tolerated. 3, muscle strength exercises should be concentrated until the muscle has a sense of soreness and fatigue, and then proceed to the next group after sufficient rest. The number of exercises, time, load depending on their own situation, and should be practiced at the same time the healthy side. The improvement of muscle strength is a key factor for joint stability, and must be practiced carefully. 4, in addition to the surgical limb brake protection, the rest of the body parts (such as the upper limbs, waist and abdomen, the healthy side of the leg, etc.) should be practiced as much as possible to ensure physical quality, improve the overall level of circulation and metabolism, and promote the recovery of the surgical local. 5, early joint mobility (flexion, extension) exercises, only one to two times a day, and strive to improve the angle can be, avoid repeated flexion and extension, multiple exercises. If the flexion angle does not progress for a long time (>2 weeks), there is a possibility of joint adhesions, so we should pay great attention to it and insist on completing the exercises. 6, mobility exercises immediately after the ice 15-20 minutes. If you usually feel swelling, pain and heat in the joint, you can apply ice again, 2-3 times a day. 7. The side with shadow in the appendix is the affected side. 8.The swelling of the joint will accompany the whole exercise process, and it is normal that the swelling does not increase with the angle exercise and activity, until the angle and muscle strength basically return to normal, then the swelling will gradually subside. Sudden increase of swelling should adjust the exercise, reduce the amount of activity, and promptly follow up when it is serious. II. Early inflammatory response period (0-1 week) Purpose: To reduce pain and swelling; early muscle strength exercises; early mobility exercises to avoid adhesions and muscle atrophy. At the early stage of functional exercises, the muscle strength level is low, the tissue has a more obvious inflammatory response, and the connection of the skeletal break is still fragile. Therefore, static exercises (joint inactivity, maintaining a certain posture until muscle fatigue) are the main focus. Gradually increase the endurance exercises with small loads, i.e., choose light loads (the amount of load to complete 30 movements that is fatigue), 30 times/group, 30 seconds rest between groups, 2-4 groups of continuous exercises, until fatigue. Avoid hip inward movement (cross-legged, etc.)! Pillow between the legs when lying down, so that the legs can not come together. Do not turn over to the affected side! Turn over to the healthy side to protect the affected leg, so that it can keep the hip slightly out of the booth during the whole movement! Put a pillow between the legs after lying on the side to keep the affected leg in a slightly outward position of the hip! Do not walk too much! Walking with crutches, the affected leg should never be stressed with weight! The walking should not be used as an exercise method! 1.After surgery, the affected leg should be placed in the straight position, and a pillow can be placed under the leg to elevate the affected leg to prevent swelling. 2. After the anesthesia subsides, start to move the toes and ankle joint, and if possible, start ankle flexion and extension activities (ankle pump exercises). Ankle Pump Exercise – forceful, slow, full range flexion and extension of the ankle joint to promote blood and lymphatic reflux through the squeezing effect of calf muscle contraction and diastole. 5 minutes/group, 1 group/hour. (See Appendix 1-Figure 1) This exercise is important for preventing swelling and deep vein thrombosis and promoting blood circulation in the affected limb, and should be practiced carefully. 3.Quadriceps and N cord muscle isometric contraction exercises >300 times/day. Quadriceps isometric exercises – i.e. thigh muscle tensing and relaxation. Should be done as much as possible without increasing pain. N cord isometric exercises – the affected leg is pressed down hard on the pillow, so that the posterior thigh muscles are tensed and relaxed. Requirements are the same as above. (See Appendix 1-Figure 2) 3 days after surgery: start CPM exercises CPM, 2 times/day, 30 minutes/time, with ice for 30 minutes immediately after the exercise (angle gradually increases with no or minimal pain) completed under the guidance of medical staff. Keep the hip slightly out of the booth during the whole exercise! Mobility and other joint activities immediately after the exercise ice for about 20 minutes, such as the usual (after standing, walking) there is a significant feeling of heat and swelling in the joint, you can ice again 3-5 times / day. Third, the initial period: (2-4 weeks) Purpose: to strengthen the mobility and muscle strength exercises. Before the hip flexion angle reaches 90°, it is absolutely prohibited to sit up in normal posture! Only half sitting up (i.e. half lying, half sitting)! 1.Start straight leg raising exercise: straight leg raising exercise: straight leg raising after knee extension to heel 15M from the bed, hold until exhaustion. (See Appendix 1-Figure 4 for the method). 2. Start active joint flexion and extension exercises: (in the absence or slight pain and fracture stability) Active hip flexion and extension exercises: sitting position, foot does not leave the bed. Slowly and forcefully, flex the knee and hip to the maximum, hold for 10 seconds and then slowly straighten. 10-20 times/group, 1-2 groups/day. See Appendix 1-Figure 13. 3.Increase the angle of CPM exercise: If the fracture is well healed, strive to reach 120° of knee flexion and nearly 90° of hip flexion in about 4 weeks. 4.Start walking with crutches on the ground: If there is no pain, the affected leg can be partially weight-bearing (less than 1/4 of body weight), pay attention to protection! Do not fall down! Fourth, the middle period: (5 weeks-3 months) Purpose: strengthen the joint mobility. Strengthen muscle strength and improve joint stability. Gradually try to improve gait with weight bearing on the affected leg. Determine if you can start weight-bearing by X-ray! 1.Weight bearing and balance exercise: (must be allowed by the degree of fracture healing) Weight bearing and balance: With the degree of fracture healing, the weight bearing gradually transitions from: 1/4 weight – 1/3 weight – 1/2 weight – 2/3 weight – 4/5 weight – 100% weight. The affected leg can be weight-bearing on a flat health scale to clarify the sensation of partial weight-bearing. The feet are separated under protection and the weight is shifted alternately from side to side within a slightly painful range, gradually until full weight-bearing standing on the affected leg can be achieved. (See Appendix 1-figure 7), 5 min/time, 2 times/day. Separate the feet anteriorly and posteriorly and move the center of gravity gradually until full weight-bearing standing of the affected side on one leg can be achieved. (See appendix 1-figure 22), 5 minutes/time, 2 times/day. 2. Continue to strengthen joint mobility exercises: (must be allowed by the degree of fracture healing) Seated leg hold: sit on the bed, hold the ankle with both hands and make the heel slowly approach the buttock. Measure the distance between the heel and the hip before starting, and gradually reduce the distance to the same angle as the healthy leg. Hold at the hip joint where you feel pain for 5-10 minutes/time, 1-2 times/day. Fixed bicycle exercises, light load to large load, and gradually reduce the height of the seat. 20-30 minutes / time, 2 times / day. 3.Start leg strength exercise Back leg lift exercise, prone (face down on the bed), the affected leg straight backward lift until the toe is 5 cm from the bed for 1 time, 30 times / group, 4-6 groups in a row, 30 seconds rest between groups, 2-3 times exercise / day. Prone position “leg hook exercise”, 10 times / group, 10-15 seconds to maintain / time, each interval of 5 seconds, 4-6 groups of continuous practice, 30 seconds rest between groups. (The method is as in Appendix 1-Figure 18, using sandbags or leather straps as load, within the range of motion of the hip joint without pain.) And gradually transition to Appendix 1-figure 17 standing leg hook exercises. Resistance knee extension exercise: as in appendix 2-figure 3-figure 5, with sandbags or leather straps as the load in the painless range of motion of the hip joint. 4, heel exercises: that is, standing on the tips of the feet, including the feet stand apart and shoulder width, the tips of the feet are forward; “external eight” standing; “internal eight” standing three positions, to practice different muscles and different parts of the muscle. 2 minutes / time, rest 5 seconds, 3-5 times / group, 2-3 groups / day. group, 2-3 groups/day. V. Late stage: (4 months – 6 months) Purpose: To strengthen muscle strength and joint stability. Full restoration of all activities of daily life. If the fracture is completely healed and has sufficient firmness, you can start the following exercises. 1.Static squatting exercises: static squatting exercises. (See Appendix 2 – Figure 1, 2) back against the wall, feet shoulder width apart, toes and knees are forward, no “internal and external eight”, gradually increase the angle of squatting (less than 90 °) with increasing strength, 2 minutes / time, interval of 5 seconds, 5-10 consecutive / group. 2-3 groups / day. 2, stride exercises: front and back, lateral stride exercises. (See Appendix 1-Figure 21, 23) 20 times/group, 45 seconds rest between groups, 4-6 consecutive sets of exercises, 2-4 exercises/day. Gradually transition to Appendix 1 – Figure 24, 25, and gradually increase the load to Appendix 2 – Figure 6, 7, 8, 9), 20 times / group, 45 seconds rest between groups, 4-6 sets of continuous exercises, 2-4 exercises / day. 3, the affected side of the single-leg 45 ° position half squat flexion and extension knee exercises. The affected leg stands on one leg, the upper body is straight, slowly squat to the 45° of flexion, and then slowly pedal until fully straightened. 20-30 times/group, 30 seconds interval between groups, 2-4 times/day. Sixth, auxiliary treatment: mobility and other joint activities immediately after the exercise ice about 20 minutes, such as the usual (after standing, walking) there is a significant feeling of heat and swelling in the joint, you can ice again 3-5 times / day. Heat therapy (herbal fumigation, wax therapy, infrared ray, etc.) to promote circulation and healing, reduce swelling, etc. Low and medium frequency electrotherapy to reduce pain or enhance muscle strength, etc. Ultrasonic therapy to promote fracture healing. Because of internal fixation, high-frequency electrotherapy and magnetic therapy can never be used!