Principle of fracture healing
The basics of fracture healing rely on alignment and immobilization. Alignment may or may not be necessary depending on the degree of displacement, the importance of correct alignment (e.g. index finger vs rib), and the patient (e.g. professional athlete vs debilitated elderly).
Immobilization can be achieved in a variety of ways depending on the location, morphology of the fracture, and device of fixation. There are 2 ways of fracture reduction they are,
Open reduction
Internal fixation (ORIF) using steel screws, rods, plates, pins, or K-wires to hold the broken bones in the correct position.
External Fixation attaches a metal framework outside the limb and includes the Ilizarov method and an X-frame
Closed reduction
It is a conservative treatment. (non-surgical management) This closed reduction Is done by hand under anesthetics. Then the traction will apply which pulls the area into the correct place.
As the bone is healing it must be immobilized and kept in the correct position. Immobilization should be done using the appropriate fixative device.
Fixation devices
Stress sharing devices
It allows micromotion between the two fractured sites and partial transmission of load, so promote secondary bone healing with callus formation, which is a relatively rapid bone healing
Example:- Intramedullary nail, casts, rods.
Stress Shielding Devices
The stress at the fracture site is transmitted through the shielding device, there is no motion at the fracture site so promote primary bone healing without callus formation, which is slower than the healing with callus formation
Example:- compression plate
Importance of Physiotherapy
Most fractures ie. broken bones will heal in usually six weeks. But that is only half of the problem. Unfortunately, when you have enough stress placed through your body to fracture a bone, there’s usually a lot of other soft tissues and structures that have been damaged in the process. Add to that the common use of immobilization in plaster, you’ll have joint stiffness and considerable muscle weakness.
This may even affect joints that don’t seem related to the break. For example, a fractured shoulder may result in a very stiff elbow or wrist just because you were keeping your shoulder in a sling for a few weeks.
When to start Physiotherapy
Physiotherapy is often recommended once the bone is aligned. Physiotherapy manipulation, electrotherapy, joint mobilization techniques, and exercises will aid in strengthening the bone and the surrounding tissue. This process will help the patient recovery by accelerating healing, reduce pain and swelling, and improve range of motion.
Remember.....
Seek treatment at an early stage.
Ensure your physiotherapist provides you with home exercises.
The physiotherapist will be involved during different phases of the recovery period.
Role of physiotherapy in fracture management
The physiotherapists' role is to identify and alleviate the reasons for loss of movement after the fracture.
The aims of physiotherapy during fracture healing will concentrate on,
Promoting healing.
Encouraging weight-bearing.
Maintaining the strength of weakened muscles.
Maintaining range of movement of the affected and surrounding joints.
Reducing pain.
Reducing swelling.
The aims of physiotherapy after the fracture has healed,
Your cast has been removed physiotherapy has to continue for 3-12 months or until you have regained your full level of function.
Progress weight-bearing activities.
Return to full function.
Return strength and the full range of movement to muscles/joints.
Focus on sport-specific rehabilitation.
Optimize the range of movement at the affected joint and prevent a recurrence.
Physiotherapy can offer you a quicker return to full function and a more positive rehabilitation outcome and it will maximize your rehabilitation potential.
What if you do not participate in Physiotherapy after a fracture.
Physiotherapy is a vital step in the rehabilitation following a fracture. If you do not participate in physiotherapy treatment after a fracture You may end up with weak lower or upper limbs and severely stiff and painful joints even though the fracture has healed well.
Dos and Don'ts during fracture healing
Do's
Do elevate your broken bone above your chest level. This will help in reducing the swelling.
Do take it easy. For the first few weeks after the fracture, you will want to take it easy
Do exercise with your physiotherapist's advice.
Do pay attention to odor, if your cast gives out a foul smell do visit your doctor immediately it may be a sign of an infection.
Do keep your cast clean.
Don'ts
Don’t ignore fever, a high temperature may indicate an underlying condition that needs medical attention.
Don’t ignore discomfort, if you experience pain, tingling, numbness, etc don’t ignore it. These are not normal signs of healing.
Don’t get your cast wet, Water may compromise the effectiveness of the material used for the cast.
Don’t apply lotion, powder, or deodorant under the cast. They may cause bacterial growth.
Do not bump or putting pressure on your fractured bone.
Do not remove the cast unless advised by the doctor. This may hamper the healing of the fracture.
zarook Hafna
Fathima Safna
References
https://www.physio.co.uk/treatments/physiotherapy/fracture-treatment.php
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