Rehabilitation of long bone fracture rehabilitation of the extremities

(I) Mechanism and role of rehabilitation

Rehabilitation after fracture can harmonize the contradiction between immobilization and movement, prevent or reduce the occurrence of complications, and make it towards the direction of fracture healing. Commonly used methods of rehabilitation include physical therapy and occupational therapy as well as traditional rehabilitation therapy of Chinese medicine. The scientific use of physical therapy can effectively control infection, eliminate swelling, promote wound repair and soften scarring. Exercise therapy, on the other hand, is therapeutic training aimed at restoring function.

Specific effects:

1. Promote the swelling to subside;

2. Prevent or alleviate myasthenia gravis

3. Prevent adhesion and stiffness of joints

4. Promote the healing of fracture

5. Enhance the effect of surgery in the later stages of dysfunction

(ii) Rehabilitation treatment methods

For the convenience of clinical rehabilitation treatment, rehabilitation after limb fracture is roughly divided by time into two stages: fracture fixation period (early) and fracture healing period (late).

1. Fracture fixation period (early)

(1) Elevation of the affected limb: this helps the swelling to subside, and the distal end of the affected limb must be higher than the proximal end, and the proximal end must be higher than the

heart level.

(2) Physical therapy: acts as anti-inflammatory, reduces swelling, relieves pain, improves blood circulation, promotes bone scab formation, facilitates fracture healing, softens scarring, and loosens adhesions.

①Ultra-short wave: the affected part is placed opposite to the fracture, within 1 week, no heat, 10 minutes / times, after 1 week, micro-heat, 10 ~ 15 minutes / times, 1 time / day, 20 ~ 30 times for 1 course of treatment. This method can be performed outside the plaster, but with metal internal fixation is prohibited.

② ultraviolet light: fracture surface area, weak erythema or erythema in the amount of daily or every other day, 6 ~ 8 times for a course of treatment. If the local plaster fixation, can be in the healthy side of the corresponding part of the irradiation.

③Magnetic therapy: use of pulsed electromagnetic therapy, the affected limb is located in the ring magnetic poles, or take the affected part of the opposite method, 20 minutes / times, 1 time / day, 20 times for a course of treatment.

4 ultrasound, audio electricity or ultrasound - medium frequency electrotherapy can be applied.

⑤Massage: massage at the proximal end of the fracture site, using centripetal maneuvers, 15 minutes/times, 1 to 2 times/day.

(3) Exercise therapy: Active exercise is the most effective, feasible, and least expensive way to prevent and eliminate edema. Active exercise helps venous and lymphatic return.

①Active exercise in all axial positions of the proximal and distal unanchored joints of the injured limb, assisted if necessary. Each time about 1 0 minutes, several times a day. Pay attention to gradually increase the intensity of activities, so as not to affect the stability of the fracture end. For upper limbs, attention should be paid to shoulder abduction, external rotation, flexion and extension of the metacarpophalangeal joints and the functional position of the hands; for lower limbs, attention should be paid to dorsiflexion and dorsiflexion of the ankle joints. Elderly patients should pay more attention to prevent adhesion and stiffness of the shoulder joint.

②The fixed part of the muscle rhythmic isometric contraction training, in order to prevent wasting muscle atrophy, and make the fracture end of the favorable, promote bone healing. Each training 1 0 minutes, several times a day.

③Intra-articular (surface) fracture, functional training should be started as soon as possible, not only to promote the repair of the articular cartilage surface shape, but also to reduce intra-articular adhesion. Generally, after 2 to 3 weeks of fixation, the external fixation device is removed for a short period of time every day, and active or passive movement without weight-bearing on the injured joint is carried out, and the fixation is continued in the original position after the end of the movement. If there is no special need for immobilization, the joint should be placed in the functional position. In this way, it can promote the repair of articular cartilage, utilize the grinding of the corresponding articular surfaces for shaping, and reduce the adhesion in the joint.

4 The healthy limbs and trunk should be maintained as much as possible to improve the general condition and prevent the occurrence of comorbidities (pressure sores, respiratory disorders, etc.).

2. Fracture healing period (late)

Each kind of fracture has an approximate healing time, but each fracture must be judged according to its own healing process and signs to determine whether healing has been completed. When a fracture has not yet healed, and misjudgment and removal of immobilization, or even premature use of the affected limb, can deform an otherwise well-positioned fracture and ultimately result in malunion. This is most commonly seen in the lower limbs, such as hip inversion in intertrochanteric femoral fractures and angulation deformity in femoral stem fractures. Fractures from clinical healing to bony healing takes quite a long time, therefore, the intensity and time of functional training has a gradual process. It should neither be ahead of time nor lagging behind. The scientific choice should be made according to the site, degree, age and the way of correction and fixation of the patient's fracture. The transition of the affected limb from non-use movement to normal use after fracture should have three conditions: (1) bone healing; (2) sufficient muscle strength; (3) a certain range of joint R O M . The goal of rehabilitation is to eliminate residual swelling, soften and stretch fibrous tissue, increase joint range of motion, increase muscle strength and train muscle dexterity.

(1) Exercise therapy

①Assisted and passive exercise: the limb that is difficult to move on its own when the cast is first removed can be assisted, and the assistance can be reduced later as the joint mobility improves. For those who have serious tissue contracture and adhesion, resulting in ineffective active movement and assisted movement, passive pulling or joint loosening technique can be used to loosen the stiff joints, but the pulling should be smooth and gentle, and should not cause obvious pain and swelling. Never use violence to avoid causing new tissue damage.

②Active movement: the affected joints are subjected to active activities in the direction of each axis of motion, including swing training and distraction training. The amplitude of the movement should be gradually increased, within the patient's tolerance, each time about 30 minutes, several times a day. Sometimes to improve the therapeutic effect, it is appropriate to carry out every hour, each time 5 ~ 10 minutes.

3 muscle strength and endurance training: when the fracture is not accompanied by nerve injury, muscle strength training is often taken resistance training, training, both the development of primary muscle strength, and the development of antagonist muscle strength. The commonly used resistance training method is the progressive resistance method, that is, heavy load (resistance), the number of repetitions can be less (about 10 times), 2 times/day. For endurance training, medium load (resistance), multiple repetitions (more than 20-30 repetitions), about 20 minutes each time, 1 time/day.

(2) Physical therapy

①Local ultraviolet irradiation can promote calcium deposition and analgesia;

②Wax therapy, infrared light, short-wave, hot compresses can promote blood circulation, soften the fibrous scar tissue, and improve the mobility of the joints, which can be used as an adjunctive therapy before manipulation;

③Ultrasonic therapy, audio electrotherapy, ultrasound - intermediate frequency electrotherapy, and iodine ion introduction can soften the scar. The introduction of ultrasound therapy, audio electrotherapy, ultrasound-mid-frequency electrotherapy, iodine ion introduction can soften the scar and loosen the adhesion. Depending on the condition, it can be used flexibly.

④For the treatment of delayed fracture healing and fracture non-healing, DC cathodic stimulation therapy, ultrasound stimulation therapy and extracorporeal vibration wave therapy can also be taken

(3) Operational therapy: for the specific dysfunctions of patients with bone fracture, from the activities of daily life, manual labor and cultural and sports activities, select some of the work that will help to restore the function of the affected limbs and skills for the treatment. In order to improve the movement skill techniques and enhance physical ability, so as to restore the patient's pre-injury A D L and work ability.