1.Why do I need rehabilitation after a fracture?
The standard of healing of fracture is not only the healing of the fracture end, but also the functional recovery of the joints and muscles adjacent to the fracture site. Many fractures, especially periarticular fractures, do not receive timely and proper postoperative rehabilitation guidance and treatment, and often leave behind dysfunction of the joints adjacent to the fracture site, resulting in joint adhesions or stiffness, causing lifelong inconvenience and pain. Fractures around the elbow and knee joints are the most common.
2.Why does joint adhesion and stiffness occur after fracture? Take the knee joint as an example
Trauma around the knee joint is the most likely to cause stiffness in the knee joint. Most of the causes of knee stiffness are due to soft tissue factors, which are divided into intra-articular and extra-articular causes, and the extra-articular causes include adhesions between muscles and bones and muscle contractures. Intra-articular adhesions are like a bearing with a long rusty interior, thus rusting its moving parts together and affecting the activities of the bearing; muscle contracture is like wearing a pair of very thin pants, and when we bend our legs, the tight pants restrict our activities; in addition, one of the activities of our knee joint is that the patella (that is, the kneecap) slides on the femoral condyles, which are inflated at the lower end of the thigh, and This sliding is caused by the pull of the quadriceps tendon, and if the quadriceps tendon sticks to the thigh bone, then it loses its role in pulling the patella to cause sliding, which also limits the movement of the knee joint, and this is the factor of muscle adhesions around the knee joint.
3.How to prevent joint adhesions?
Prevention of joint stiffness is more important than cure! The focus is on early exercises of joint flexion and extension activities under professional guidance without affecting the healing of the fracture.
Whether it is fracture patients in the trauma ward or joint replacement and arthroscopic patients in the joint ward, they receive safe, standardized, scientific and effective rehabilitation treatment in the early postoperative period, and the bedside functional exercises promote the recovery of joint and limb functions to the maximum extent, while avoiding the occurrence of joint stiffness to the maximum extent. Unfortunately, such a model of perioperative rehabilitation in orthopedic wards is still far from popular in China. The phenomenon of beautiful surgery and very poor function is common.
4.How to treat the formed joint adhesions and stiffness?
Early stage patients can go to the rehabilitation clinic to receive conservative rehabilitation treatment. The Department of Rehabilitation Medicine of the Ninth Hospital has developed a set of effective rehabilitation treatment programs, including soft tissue loosening, joint loosening, brace stretching and other means. As a department featuring orthopedic rehabilitation, years of practice have allowed them to accumulate a wealth of experience in dealing with joint stiffness. For joint stiffness simple rough pressure, breaking is not desirable, because such a method not only can not solve the whole problem will also bring new injuries and complications such as heterotopic ossification, or even cause fractures such serious consequences, causing the joint function to snowball. Therefore, it is recommended that patients go to rehabilitation medicine to receive more specialized rehabilitation treatment, especially arthroplasty. Of course, nowadays, the rehabilitation medicine departments are mainly focused on neurological rehabilitation (stroke hemiplegia), so patients should still choose a specialized rehabilitation featuring orthopedic rehabilitation.
For patients in advanced stages, rehabilitation doctors either refer them directly to the orthopedic department for minimally invasive release surgery and follow up rehabilitation in a timely manner after surgery (many patients often obtain unexpected results after such systematic treatment), or decide whether to operate after a period of rehabilitation treatment based on the response to the efficacy.
The Department of Orthopaedics and the Department of Rehabilitation of the Ninth Hospital have joined forces in the prevention and treatment of joint stiffness, bringing a boon to patients with orthopaedic injuries. Perioperative rehabilitation plays a vital role in the prevention of joint stiffness; it greatly reduces the disability rate of bone and joint diseases. The conservative rehabilitation of joint stiffness and the combination of rehabilitation after minimally invasive release surgery have brought hope to those patients who have already caused functional impairment.
5.What is the best time for rehabilitation after fracture?
Due to the institutional problems of many hospitals, post-operative orthopedic patients usually do not receive early rehabilitation treatment during their hospitalization and are not given detailed rehabilitation instructions upon discharge. Patients usually return to the orthopedic outpatient clinic for a follow-up appointment 4-6 weeks after surgery. The reason why 4-6 weeks is because after such a long period of time the fractures in the extremities basically have an initial healing. This is the “honeymoon period” of fracture rehabilitation, because the patient should cooperate closely with the rehabilitation treatment during this period, i.e., honeymoon with the rehabilitation. Unfortunately, this is the best time for patients to spend at home. Due to the lack of professional guidance, the fact that the patient is not a professional, and the influence of traditional Chinese culture, which says “it takes a hundred days to break a bone”, most patients take the approach of rest and basic immobility. To be conservative, let the bones grow longer and firmer.
After 4-6 weeks, the limb joints will show varying degrees of loss of mobility and joint adhesions at the time of follow-up. At this point, most orthopedic surgeons in the hospital will tell the patient to go home and do more exercises on their own, without any detailed and professional rehabilitation guidance. This is because orthopedic surgeons specialize in surgery, not rehabilitation. Patients will be asked to come back to the orthopedic department in 1-2 months after this follow-up visit.
The “golden period” for post-operative rehabilitation is usually 6 weeks to 3 months after surgery, when the fracture has initially healed and the rehabilitation is effective. Again, unfortunately, most patients do not receive professional treatment from the rehabilitation department because they are not recommended by their orthopedic surgeon and they lack general knowledge in this area. It is undeniable that there are a certain number of patients who can basically restore the function of their joints and limbs with their own exercises, but it is also an inescapable fact that we see many patients with periarticular or intraarticular fractures and complex fractures in our outpatient clinics who miss the golden period of rehabilitation and end up with irreversible sequelae.
The period from 3 months to 6 months after surgery is called the “late stage” of fracture rehabilitation. The treatment is also much more complicated than the previous “honeymoon” and “golden period”, and requires more professional manipulation and joint release brace stretching to make the final effort. After 3 months of intensive rehabilitation, there is still a chance to save the lost joint function to the maximum extent possible. In fact, patients are lucky to come to the rehabilitation department in time to receive professional treatment at 3 months after surgery.
If a patient comes to the rehabilitation department six months after surgery, we usually recommend that the patient go directly to the orthopedic department to receive minimally invasive or open release surgery and then receive rehabilitation after surgery, because the joint contracture is already fixed at this time and conservative treatment has little effect, so it is not worth spending more time and energy. Otherwise, the postoperative function may be worse than the preoperative function.
When should I come to the rehabilitation department after fracture surgery? It is generally recommended to visit the rehabilitation department 2-4 weeks after surgery. Once functional limitation occurs, you should come to the rehabilitation department to receive professional rehabilitation treatment in a timely manner. It is best not to miss the “golden period” of 3 months after surgery, and to go to a rehabilitation department specializing in orthopedic rehabilitation at least before 5 months after surgery.
6. Is it possible to recover from joint adhesions without pain?
In my clinic, I often see many patients with knee and elbow joint adhesions and stiffness, who have received a lot of manipulative treatments that cause severe pain before coming to our department. In the end, these patients are often not treated as well as they should be. Their doctors often told the patients that they would not get better without pain, and the patients believed that they would not be able to pull the adhesions apart without pain, so they endured the pain from the treatment every day.
I often tell my patients that this is like a hunchback, can it be flattened by using two door plates? Imagine if an elbow or knee joint that cannot be flexed can be restored by simple and brutal hard wrenching, then there is no need to go to a hospital rehabilitation department to receive professional treatment for such physical work.
Joint adhesions and stiffness are called joint contractures in medical terminology, and the causes of joint contractures are complex, both intra-articular and extra-articular, and the treatment strategies and techniques for different causes and stages of joint contractures are different. The treatment strategies and techniques for different causes and stages of joint contracture will vary. These need to be determined by the physician through careful examination and professional analysis. Treatment techniques for joint contractures include soft tissue release, joint release, joint traction, and continuous progressive distraction. Contrary to what many lay people express, none of these treatment techniques for joint contracture cause significant pain to the patient. Not only are they painless, but their adherent joints always gain a significant increase in mobility with a single treatment.