PRINCIPLES OF SURGICAL MANAGEMENT TREATMENT

ROLE OF PHYSIOTHERAPIST 1. To work as a part of the multidisciplinary team. 2. To assess the patients condition and identify his needs. 3. To explain any proposed physical treatment, and its aims to the patient. 4. To maintain respiratory function especially for those patients with respiratory disease, thoracic cage injury or spinal injury. 5. To rehabilitate the patient back to independence. 6. To be aware of likely complications and to report any untoward signs and symptoms to the ward in charge or to the doctors.

PRINCIPLES OF PHYSIOTHERAPY 1.The maintenance of normal movement and function of the uninjured structures. 2.The restorations of normal movement and function of the fractured area as soon as possible. New treatment methods, e.g.. Functional bracing, have increased patient mobility allowing rehabilitation to be carried out as union proceeds.

ASSESSMENT Assessment: Before commencing the treatment the physiotherapist should make an assessment which should be repeated at intervals. This includes reading the medical notes and looking at the radiographs. The following should be noted:

1.Diagnosis and date of injury. 2.Cause of injury. 3.Other injuries, illness and complications 4. Occupation. 5. Home circumstances. 6. Symptoms: Ask about pain, stiffness and function. 7. Signs at the fracture site: Local heat, redness, oedema and tenderness. 8. Signs in the near by joints: Effusion and range of movement. 9. Signs in the whole limb: Muscle power/wasting and sensation. 10. General examination: Functional activity and respiratory function. FRACTURE CONSERVATIVE METHOD DURING IMMOBILIZATION 1. ELEVATING THE PART. 2. ACTIVE EXERCISES TO MOBILISE ALL MUSCLES AND JOINTS NOT INCLUDED IN THE SPLINTAGE. 3. ISOMETRIC EXERCISES FOR THE MUSCLES ENCLOSED IN THE SPLINTAGE TO PRESERVE MUSCLE FUNCTION AND PREVENT ATROPHY 4. ENCOURAGEMENT OF NORMAL PATTERNS OF MOVEMENT: THIS WILL INCLUDE GAIT IF THE LOWER LIMB IS INVOLVED. IF THE PATIENT IS TO BE ALLOWED NON-WEIGHT-BEARING OR PARTIAL WEIGHTBEARING THE USE OF CRUTCHES MUST BE TAUGHT; THIS INCLUDES THEIR USE IN RISING FROM SITTING AND FROM STANDING TO SITTING, A RECIPROCAL GAIT (SHADOW WALKING IF NON-WEIGHT-BEARING), STEPS AND STAIRS (CLIMBING UP: NORMAL LEG IS USED FIRST, DURING MOBILIZATION 1.HEAT THERAPY- WAX BATH TO REDUCE PAIN AND PRODUCE RELAXATION 2.PASSIVE MEOVEMTNS 3.JOINT MOBILIZATION 4.STRETCHING 5.PARTIAL WEIGHT BEARING TO FULL WEIGHT BEARING 6.FUNCTIONAL ACTIVITIES

CLIMBING DOWN: AFFECTED LEG IS USED FIRST- IN SURGICAL INTERVENTION) GAIT PATTERN: NON-WEIGHT BEARING TO PARTIAL WEIGHT BEARING TO FULL WEIGHT BEARING. THREE POINT GAIT TO FOUR POINT GAIT TO TWO POINT GAIT.

FRACTURE TREATED IN TRACTION PROLONGED TRACTION MAY CAUSES COMPLICATIONS LIKE STIFNESS AND MUSCLE WASTING SO ITS RECNTLY PREVENTED BY FCB.

DURING IMMOBILIZATION
1. DEEP BREATHING EXERCISE, COUGH TECHNIQUE AND HUFFING TECHNIQUE. 2.ANKLE AND TOE MOVEMENTS 3.STRENGTHENING EXERCISE TO UPPER LIMB AND UNAFFECTED LEG. CARE MUST BE TAKEN WITH RESISTED EXERCISES IN THE FIRST FEW WEEKS BECAUSE OVERFLOW OF MUSCLE ACTIVITY TO THE AFFECTED LEG MAY ALTER THE POSITION OF THE FRACTURE AND ACTUALLY DELAY REHABILITATION. 4. ISOMETRIC CONTRACTIONS OF MUSCLES IN THE AFFECTED LIMB, ESPECIALLY THE QUADRICEPS GROUP. 5. PASSIVE MOBILIZATION OF THE PATELLA OF THE FRACTURED LEG TO PREVENT PATELLO-FEMORAL ADHESIONS.

DURING MOBILIZATION
1.HEAT THERAPY- WAX BATH TO REDUCE PAIN AND PRODUCE RELAXATION 2.PASSIVE MEOVEMTNS 3.JOINT MOBILIZATION 4.STRETCHING 5.PARTIAL WEIGHT BEARING TO FULL WEIGHT BEARING 6.FUNCTIONAL ACTIVITIES

FRACTURE TREATED BY SURGERIES-ORIF AIMS

1. To reduce any swelling. 2. To restore full range of joint movement. 3. To restore full muscle strength and function. 4. To promote full distal range of movement and strength. 5. To maintain previous ADL function. PHYSIOTHERAPY TREATMENT 1. Active-assisted and active ROM to the involved fractured site to maintain mobility and to prevent contractures. 2. Isometric exercises (e.g.) gluteal and quadriceps should start and neuromuscular electrical stimulation to minimize muscle atrophy. 3. Elevation of the limb. 4. Ankle and toe movements - Active distal movements to maintain circulation and to decrease the possibility of thromboembolic disease. 5. Light manual resistance exercises. 6. Gait training (3 point gait - 4 point gait - 2 point gait). 7. Stair case climbing Climbing up the stair case - Normal leg first and then the operated leg Climbing down the stair case - operated leg first and then the normal leg. 8. Progressive closed-chain exercises to improve the strength, endurance, stability and balance.