Pain
This is the most common factor that affects motor dysfunction, and I think this is well understood.
It is now believed that: acute pain is a symptom of a disease, while chronic pain is a disease state in itself.
Acute pain after trauma and orthopedic surgery is severe and long-lasting, and combined with a longer postoperative inability of the patient to move, can produce dysfunction in mental and physical activity.
Burning neuralgia is a severe burning-like pain syndrome that occurs after peripheral nerve injury to the extremities.
For example, it is detected 5 to 10 days after the hand injury, or individually as early as a few hours or as late as 1 to 2 months. Pain usually begins, but soon spreads proximally to the affected limb and worsens with skin congestion. There is even muscle atrophy and joint stiffness.
Swelling
Persistent swelling is the most significant cause of disability after a joint injury. That is why the beginning of our rehabilitation usually starts with dealing with swelling. If the edema lasts for more than 2 weeks, it is eliminated by mechanization and eventually forms fibrous scar tissue in the muscles, tendons, joint capsule, fascia and other tissues, which leads to limitation of movement, so early management of swelling is very important.
Joint adhesions and stiffness
Injuries within or adjacent to the joint area can easily cause intra- and peri-articular adhesions. Even if the non-articular site is injured, due to the prolonged immobilization beyond the joint (e.g., long-legged plaster cast type), it is difficult to perform effective joint movement in that joint, poor venous blood and lymphatic return to the limb, deposition of plasma fibrous exudate and fibrin in the tissue spaces, and fibrous adhesions in and around the joint tissue. Moreover, the joint capsule and ligaments pass through the muscles of the joint, and the tendons contract, and the joint becomes dysfunctional to varying degrees.
Muscle atrophy
Disuse atrophy of muscles, resulting in decreased muscle strength and dynamic instability of the joint (e.g., knee instability and hyperextension due to atrophy of the quadriceps muscle). Muscle adhesions and fibrous degeneration (e.g., ischemic myonecrosis) then limit the movement of the corresponding joint because of loss of muscle action and reduction in contraction amplitude.
Joint instability
Injuries to the structures that maintain joint stability, especially ligaments, that are not effectively repaired can lead to secondary joint laxity and joint instability. For example, unrepaired compound injuries to the cruciate ligaments of the knee may affect ADLs, such as difficulty in walking up and down stairs.
Joint pain
It is mainly caused by traumatic arthritis and mostly occurs in intra-articular fractures and dislocations. The main cause is not only mechanical wear and tear caused by uneven joint surface, but also the disturbance of load transmission.
Deformed healing or non-healing of fractures
Deformed healing of the fracture causes disorders of joint function, uncoordinated movement between the joints of the limb, imbalance and abnormal gait, and weakened muscle action. For example, rotational deformity of the ulnar radius of the forearm can cause rotational disorders: intertrochanteric fracture of the femur with inversion deformity of the hip causes relative relaxation of the gluteus medius muscle and loss of pelvic stabilization, resulting in a duck gait (frontal plane swaying gluteus medius gait) during the weight-bearing phase of walking.
Nerve injury
Central or peripheral nerve injury, or fracture displacement and compression along the nerve or later encapsulation by bone scabs, fracture deformity (e.g., ulnar neuritis caused by elbow valgus deformity left by lower humerus fracture), etc., cause nerve dysfunction and paralysis of the innervated muscles.
Epiphyseal injury
Epiphyseal injuries in children, such as epiphyseal fractures and separation, may directly affect the early closure of the epiphysis in that area. The result is developmental disorders or shortening of the limb compared to the normal side or deformity of the bone end, such as: radial deviation deformity of the lower forearm and fishtail deformity of the lower humerus.
Tissue Defects
Severe open injuries often result in limb bone defects or soft tissue defects such as skin, muscle, etc. There is no possibility of surgical reconstruction to repair and leave functional impairment.
Complications of orthopedic management
Orthopedic surgery is an important tool in the treatment of bone and joint injuries, and various complications may arise due to many aspects.
For example, nerve damage caused by traction of the limb (ulnar nerve damage caused by traction of the ulnar hawk): too tight fixation of the cast, causing impaired blood circulation in the limb, muscle necrosis and twinning, and even limb necrosis.