Fracture and dislocation problems fall under the field of orthopedics and traumatology. However, complaints such as muscle wasting, joint stiffness, and pain may occur after fractures treated with surgery or plaster casts. Therefore, physical therapy may be required after the treatment of fractures by orthopedic specialists. The process of returning to normal life after full union is achieved is the responsibility of the physical therapy and rehabilitation specialist. Close communication with the orthopedic specialist should also be possible, especially in the early period of post-fracture rehabilitation.
In the treatment of fracture, the separated bone ends are brought back together and aligned. Simple fractures can be manually corrected and placed in a cast by the orthopedic doctor. In more severe fractures, placement is achieved by surgery with a method called open reduction internal fixation (ARIF). Tools such as pins (K-wire), plates and screws, nails (intramedullary nails) are used to attach bone fragments to each other. Surgically placed orthopedic implants are usually permanent, but in some cases they may need to be removed with a second operation.
Historically, immobilization has been a key element in fracture healing. In order for the bone to fuse properly, it must be fixed with plates and screws, an external fixator or a plaster-splint, depending on the nature of the fracture. However, over time, the importance of the movement was better understood. Because being inactive for a long time can lead to thinning of the muscles, shortening of the tendons and ligaments, even osteoporosis, formation of clots in the vessels or abnormal response in the sympathetic nerves (reflex sympathetic dystrophy). Therefore, for the best treatment, immobility and movement must be well managed.
Fracture Healing Stages
Bone is a living tissue that is constantly made and destroyed, with good blood supply. Unlike other tissues such as nervous tissue, it has a high self-repairing capacity. Most fractures heal without scarring and the bone can regain its former strength. Fracture healing occurs in three phases. The first 1-2 weeks is the period when the activity of inflammatory cells, called the inflammatory phase, is high. Then comes the repair phase, which may take several months. The progenitor cells form the healing tissue called callus, which consists of connective tissue, cartilage and bone tissue. Finally, there is the remodeling phase. In this phase, which lasts for months or even years, the bone tissue is reorganized through the processes of construction and destruction, its strength increases and the fracture scar can completely disappear.
Post Fracture Rehabilitation
Post-fracture rehabilitation often begins while the patient is still in the orthopedic ward. Getting the person with a leg or foot fracture to their feet as early as possible with assistive devices such as crutches or walkers ensures rapid recovery. It also prevents complications such as intravascular clot formation (deep vein thrombosis). In the early period, it may be necessary not to load at all on the fractured side or not to load more than a small percentage of body weight. A limit can be set for the load that can be carried in arm fractures. The orthopedic doctor decides how much loading is correct. The physiotherapist, on the other hand, pays attention to these limitations and plans and implements exercises that will improve muscle strength, range of motion and functional capacity. Orthoses such as knee braces and AFOs can help make movements more secure.
After being discharged from the orthopedic clinic, the physical therapy home program can be applied by being admitted to the outpatient physical therapy or physical therapy and rehabilitation clinic. Physical therapy can be applied more intensively after the fracture is healed and movements around the fracture can be started. To reduce pain and edema, to stretch and strengthen the muscles, if walking is affected, walking exercises and exercises to increase general functionality are performed. For this purpose, electrical stimulation, contrast bath , hot or cold applications , ultrasound therapyTools such as scar tissue massage and mobilization techniques can be used. Hydrotherapy, body weight supported treadmill, non-gravity treadmill, robotic walking systems can also be preferred in suitable patients in order to exercise without being overloaded.
How Long Does It Take to Heal After a Fracture?
In general, fracture healing is completed in 8 weeks. Return to normal life can occur in 12 weeks. The rehabilitation process takes an average of 6-8 weeks. Of course, these periods may increase or decrease depending on factors such as the type of fracture, general health status of the person, and complications.