I. Reset
(1) Early reduction of fracture can make fracture repair go smoothly. There are two reduction methods: manual reduction and surgical reduction. If the reduction time is too long, it will make fracture reduction difficult.
Bone separation and reduction is the first step in fracture treatment. Therefore, for each fracture, in principle, we must strive for anatomical alignment. For some fractures, it is difficult to reset. Although the fracture has not completely recovered to the anatomical position, it will not affect the function of the injured limb after healing, which is called functional counterpoint. In the treatment of fracture, we should pay attention to the functional recovery of the affected limb, rather than unilateral and mechanical forced anatomical reduction.
If the local swelling of the injured limb is serious, or even skin blisters are formed, it is more difficult to reset. At this time, we still have to fight for fracture reduction. If we passively wait for the swelling to disappear, the reduction time will often be postponed.
When the wounded are in coma, shock, or complicated with internal organs, brain and other injuries, they should concentrate on rescue first, and then perform fracture reduction after the whole body is stable.
(2) the standard of reduction Generally speaking, fracture reduction should strive for anatomical counterpoint or close to anatomical counterpoint. However, in clinical practice, due to the differences in fracture site, fracture type, swelling degree of fracture after injury, equipment conditions during reduction and technical level of the restorer, the affected limb should be restored to the best degree as far as possible according to the specific situation. The principle is that the limb function of the patient will not be affected after fracture repair.
1. Upper limb: humeral fracture, multiple shortening deformity and lateral displacement, the angulation is slightly greater than 5 ~10, which has little effect on the function of the affected limb. The fracture of flexor ulnaris is strict. Lateral displacement is less than 50%, and angulation below 5 ~10 has little effect on forearm pronation and supination function. The flexor ulnaris must be repaired at the same time.
2. Lower limbs: the fracture of lower limbs is shortened by no more than 2cm. Too short will cause lines to break, and long time will cause hip and waist pain. The rotational displacement should be corrected as much as possible. Both internal rotation and external rotation of lower limbs will affect the gait of lower limbs.
3. Children: Children's fracture reduction requires a wide range, generally angulation, rotation deformity, slight shortening or lateral displacement below 15. In the development of children, their reliable and powerful shaping ability has been compensated, and there will be no obvious dysfunction in the future.
4. Intra-articular fracture: Intra-articular fracture with bone seam passing through the articular surface requires high reduction, so anatomical reduction should be sought. For intra-articular fractures, surgical reduction and internal fixation should be considered as appropriate if manual reduction cannot achieve satisfactory anatomical reduction.
(3) the method of reset
1. Manual reduction: In the treatment of fracture, manual reduction is the most widely used and the safest. After reduction, it is necessary to carefully check the shape and length of the fractured part of the affected limb and whether it has returned to normal. After proper and effective external fixation, X-ray fluoroscopy or radiography were performed to confirm the reduction results. If the reset is poor, correct it as needed.
2. Traction reset: traction can be used as both a method of reset and a measure to keep reset. It is mainly used for fractures that cannot be reduced by manual traction or are unstable after reduction.
3. Open reduction: it is an important cause of fracture nonunion, so we should choose carefully and strictly control the indications to prevent abuse. The following conditions can be used as reference indications for open reduction: ① Fracture involves articular surface, and manual reduction can not achieve good alignment of articular surface. ② After fracture, the muscles attached to the bone fragments contract, which makes the bone fragments shift and difficult to fit. (2) The fracture ends are sheared, the blood supply is poor, and the broken bones need strict fixation to heal, such as the intra-capsule fracture of femoral neck. ④ Soft tissues such as muscle, tendon, periosteum and nerve were embedded between the broken ends of the fracture, and manual reduction failed. ⑥ There are multiple fractures on one bone, which makes manual reduction difficult. ⑥ Patients with unstable fracture of long bone shaft who are not satisfied with manual reduction and are not suitable for traction treatment, but have good internal fixation effect. (8) Fracture is accompanied by rupture of main blood vessels of limbs, and the bone scaffold should be reconstructed first, such as partial or complete amputation. Pet-name ruby fracture is not connected or abnormal healing occurs, and the function recovery is poor.
Two. Solid love
Correct and effective fixation is one of the keys to fracture healing. It can continue to maintain the alignment after fracture reduction, and can also prevent shear force and angular movement that are not conducive to fracture healing. There are two commonly used fixing methods. After fracture reduction, external fixation was used to fix the injured limb, including small splint, plaster bandage and continuous traction. After fracture reduction, the internal fixation of the injured limb is internal fixation, including screws, steel plates, triangular needles and intramedullary nails. After internal fixation, external fixation is often used for short-term or long-term cooperative fixation to make the curative effect more reliable.
3. Functional exercise
Early and reasonable functional exercise can promote blood circulation, reduce muscle atrophy, maintain muscle strength, prevent joint stiffness and promote fracture healing. Therefore, the fixed limbs should be properly contracted and relaxed. For unfixed joints, patients should be encouraged to do active functional exercise in time, and gradually strengthen weight-bearing exercise when the fracture end has reached clinical healing.
There are two forms of clinical functional exercise: active exercise and passive exercise.
(1) Active exercise is the main form of functional exercise. According to the patient's mobility, under the premise of not affecting the displacement of the broken end of the fracture, muscle contraction and relaxation and various movements of unfixed joints should be carried out as soon as possible to promote blood circulation, enhance physical fitness, reduce the traumatic reaction to the whole body and prevent joint stiffness. Therefore, in the whole process of fracture repair, we should take active exercise. Specifically, it can be divided into two stages:
1. The first stage: although the broken end of the fracture has recovered within 1-2 weeks, it is unstable and occasionally accompanied by slight lateral displacement or angulation deformity. At this time, the soft tissue injury complicated by fracture still needs to be repaired, and local pain and limb swelling still exist. Therefore, the main form of exercise is to relax through muscle contraction and flexion and extension of upper and lower joints without affecting the displacement of the broken end, thus helping blood return, promoting the swelling to subside and playing a preventive role. For example, after reduction and fixation, you can perform flexion and extension movements of interphalangeal joints and metacarpal joints, finger adduction and abduction, elbow flexion and extension, shoulder flexion and extension, adduction and abduction, rotation and other movements.
After 2-3 weeks of fracture, the swelling and pain of limbs have been obviously relieved, the soft tissue trauma has been basically repaired, callus has begun to form, and the broken ends have been initially connected. In addition to strengthening muscle contraction and relaxation, other joints can gradually increase their range of motion, from single to several joint collaborative exercises. The patient on the traction frame can also drive the activity of the affected limb through the contraction and relaxation of muscles and the movement of other parts of the body.
2. The second stage: At this time, the fracture has reached the clinical healing standard. After external fixation and traction are released, in addition to the control of joint activity during fixation, some patients may also have symptoms such as joint adhesion, joint capsule contracture and limb edema due to poor initial movement. Therefore, it is necessary to continue to encourage patients to strengthen functional exercise and cooperate with external washing and massage of traditional Chinese medicine to promote the rapid recovery of joint activity and muscle strength. In addition, physical therapy can be properly combined according to the needs of the disease, but it should still be based on active exercise.
(2) Passive motion
1. Massage: It is suitable for limbs with swelling at the broken ends of fractures, and slight massage can help the swelling subside.
2. Passive joint movement: In the early stage of fracture fixation, a few patients dare not take the initiative for fear of pain, so it is advisable to carry out auxiliary activities with the help of medical staff to promote patients to take the initiative better. It has a certain effect on eliminating swelling as soon as possible, preventing muscle atrophy and adhesion and joint capsule contracture, but the operation should be gentle to prevent the fracture from shifting again and aggravating local trauma.
(3) Matters needing attention in functional exercise
1. Functional exercise must be carried out under the guidance of medical staff.
2. Functional exercise should be based on the stability of fracture, and gradually increase the activity amount and time from slight activity, so it is not appropriate to rush. If the broken bone is displaced again due to sudden and violent activity, some patients should be prevented from exercising under the correct guidance of medical staff, and such patients should be patiently persuaded.
3. Functional exercise is to accelerate fracture healing and restore the function of the affected limb. Therefore, patients should be encouraged to persist in exercise, carry out activities that are beneficial to fracture healing, and strictly prevent activities that are not conducive to fracture healing, such as abduction of humeral surgical neck fracture, adduction of adduction fracture, abduction of abduction humeral supracondylar fracture, flexion of flexion fracture, rotation of forearm fracture, internal and external rotation of tibia and fibula shaft fracture, and extension and flexion of lower radius fracture.