What Is an Intra-Articular Fracture?

Intra-articular fracture rehabilitation is a kind of rehabilitation treatment. The rehabilitation assessment mainly evaluates the diagnosis of pain and shutdown function. Later rehabilitation can target specific dysfunction of fracture patients. From daily life activities, manual labor and cultural and physical activities, some are selected. Helps restore the function and skills of affected limbs for treatment. In order to improve motor skills and enhance physical fitness, the patient's ADL and work ability can be restored before injury.

Intra-articular fracture rehabilitation

Intra-articular fracture rehabilitation is a kind of rehabilitation treatment. The rehabilitation assessment mainly evaluates the diagnosis of pain and shutdown function. Later rehabilitation can target specific dysfunction of fracture patients. From daily life activities, manual labor and cultural and sports activities, some Helps restore the function and skills of affected limbs for treatment. In order to improve motor skills and enhance physical fitness, the patient's ADL and work ability can be restored before injury.

Chinese name

Intra-articular fracture rehabilitation

Attributes

books

Related field

Medical

Related disciplines

Rehabilitation therapy

1. Definition: Intra-articular Fracture refers to a fracture in the joint capsule. There may be two cases, one is a fracture that affects the articular cartilage surface, such as a tibial plateau fracture, a metatarsal fracture, an humeral internal and external condylar and intercondylar fracture of the elbow joint, a small humeral head fracture, a radial head fracture, a ulna olecranon fracture, and an internal and external ankle Fractures, femoral head fractures, scaphoid fractures, etc .; the other is fractures that do not affect the articular cartilage surface, such as femoral neck fractures, radial neck fractures, etc. ^[1]

1. Pain-Early inflammation of joint fractures and advanced traumatic arthritis can cause pain, soreness and discomfort, varying in degree and duration, and may cause many other problems, so relieving pain is rehabilitation The important purpose of treatment is also the urgent requirement of patients.

2, joint movement disorders-because muscles can not effectively play contractile movements, resulting in poor venous and lymphatic reflux, serous fibrous exudates and fibrous adhesions in the tissue space. Due to the secondary contracture of the joint capsule, ligaments, muscles, and tendons, these are common and important causes of joint mobility disorders.

3. Decreased ability of daily living activities-joint pain caused by joint fractures and dyskinesia, which affects daily life and work to varying degrees, even dressing, grooming, lifting, personal hygiene, standing and walking, stool control, etc. Basic activities are restricted.

4. Psychological disorders-joint pain caused by intra-articular fractures, symptoms may recur, sometimes light and severe, some patients may appear pessimistic, fear and anxiety; in addition, pain, joint stiffness caused by severe intra-articular fracture And the decline in daily living activities can also lead to serious psychological disorders.

(I) Evaluation of pain Pain is the most common symptom. The location of the pain is related to the type and location of the lesion. Generally around the affected joint, it can also cause pain in the adjacent joints. The limbs on the contralateral side are painful, or the back and pain are caused by abnormal standing and walking postures.

1. Visual Analog Scale (VAS)

The VAS scoring method is simple, fast, and easy to operate. It is widely used in clinical practice and is a common method for measuring pain intensity. Take a straight line with a length of 100mm, the left end (or upper end) of the straight line represents "no pain", and the right end (or lower end) of the straight line represents "unbearable pain". The tester asks the patient to mark the pain intensity they feel on a straight line, and the distance between the left end (or upper end) of the line and the marked point is the patient's pain intensity. Unmarked straight lines were used for each measurement to avoid subjective errors when patients compared the marks before and after. The VAS scoring method can not only measure the intensity of pain, but also the degree of pain relief and other aspects such as the degree of emotion and functional level.

2. Simplified McGill pain scale

The McGill Pain Rating Scale (MAP) is an internationally recognized scale for describing and measuring pain. It divides pain into three major categories: sensory, emotional, and judgmental. It contains 78 words, which can sensitively and effectively measure pain Nature and strength, but due to the large number of vocabularies, it is difficult to accurately understand, and some words are difficult to find Chinese counterparts, which is limited in clinical applications. The simplified MPQ reduced the vocabulary to 15 and added the content of the visual analog scale (VAS), which greatly improved its practicality. Clinical experiments have confirmed good correlation with standard MPQ. In China, simplified MPQ has been applied to compare the nature, intensity, and changes before and after treatment of patients with acute, chronic, and postoperative pain. It shows that simplified MPQ has high reliability, good validity, and simplicity. It is a practical Valuable pain measuring tool. The simplified McGill pain score table mainly includes six indicators: word selection items, pain rating index (PRI) sensory score, emotional score and total score, visual analog rating (VAS), and existing pain intensity (PPI).

(B) joint function assessment

1. Fracture healing: Pay attention to the fracture alignment and epiphyseal formation; pay attention to whether there are poor healing such as delayed or unhealed, pseudo joint formation, deformity healing, etc .; pay attention to infection and blood vessel, nerve injury, joint Complications such as contractures and ossifying myositis.

2, joint mobility assessment

(1) Measurement of joint mobility ^[5]

Rehabilitation mechanism and role of intra-articular fractures

Post-fracture rehabilitation can coordinate the contradiction between fixation and movement, prevent or reduce the occurrence of complications, and make it develop towards the direction of fracture healing. The common methods of rehabilitation are physical therapy and occupational therapy, as well as traditional rehabilitation methods of traditional Chinese medicine. The scientific use of physical therapy can effectively control infection, eliminate swelling, promote wound repair, and soften scars. Exercise therapy is therapeutic training aimed at restoring function.

Specific role:

1. Promote swelling subsidence;

2. Prevent or reduce muscle atrophy

3. Prevent joint adhesion and stiffness

4.Promote fracture healing

5.Improve the effect of postoperative dysfunction

Intra-articular fracture rehabilitation

In order to facilitate clinical rehabilitation, the rehabilitation of intra-articular fractures is roughly divided into two phases: fracture fixation (early) and fracture healing (late).

1. Fracture fixation (early)

(1) Elevation of the affected limb: It helps to reduce swelling. The distal end of the affected limb must be higher than the proximal end, and the proximal end must be higher than

Heart plane.

(2) Physiotherapy: Anti-inflammatory, relieve swelling, relieve pain, improve blood circulation, promote callus formation, promote fracture healing, soften scars, and release adhesions.

• Ultrashort wave: the affected part is opposite, within 1 week of fracture, no heat, 10 minutes / time, after 1 week, micro-calorie, 10-15 minutes / time, 1 time / day, 20-30 times is a course of treatment. This method can be performed outside of gypsum, but it is prohibited when there is a metal internal fixation.

• Ultraviolet rays: the body surface of the fracture, the amount of weak erythema or medium erythema, once a day or every other day, 6 to 8 times is a course of treatment. If local plaster is fixed, it can be irradiated on the corresponding part of the healthy side.

• Magnetic therapy: Pulsed electromagnetic therapy is used. The affected limb is located in a ring-shaped magnetic pole, or the opposite part of the affected part is used. 20 minutes / time, 1 time / day, 20 times is a course of treatment.

• Ultrasound, audio frequency or ultrasound-medium frequency electrotherapy can be applied.

• Massage: Massage at the proximal end of the fracture site, using concentric techniques, 15 minutes / time, 1 to 2 times / day.

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

• Active movements on the various positions of the unfixed joints of the proximal and distal ends of the injured limb are assisted if necessary. About 10 minutes each time, several times a day. Pay attention to gradually increase the intensity of activity, so as not to affect the stability of the fracture end. Should pay attention to shoulder abduction, external rotation and palm knuckle flexion and extension movement and functional position of the hand; lower limbs should pay attention to ankle dorsiflexion and dorsiflexion. Elderly patients should pay more attention to prevent shoulder joint adhesion and stiffness.

• Rhythmic isometric contraction training of fixed site muscles is performed to prevent disused muscle atrophy, make the fracture ends more favorable, and promote bone healing. Train around 10 minutes each time, several times a day.

• Intra-articular (face) fractures, functional training should be started as early as possible, which can not only promote the repair and shaping of the articular cartilage surface, but also reduce intra-articular adhesions. Generally, after 2 to 3 weeks of fixation, the external fixation device is removed daily for a short period of time to carry out active or passive movements that do not bear the weight of the damaged joint. After the exercise, the fixation is continued in place. If there is no special need for fixation, the joint should be placed in a functional position. In this way, it can promote the repair of articular cartilage, use the grinding and shaping of the corresponding articular surface, and reduce the adhesion in the joint.

• Healthy limbs and trunks should maintain their normal activities as much as possible to improve the overall condition and prevent the occurrence of comorbidities (pressure ulcers, respiratory diseases, etc.).

2. Fracture healing period (late stage)

Each fracture has an approximate healing time, but each fracture must be judged based on its own healing process and signs to determine whether it has completed healing. When the fracture has not healed, and the judgment is wrong and the fixation is removed, or even if the affected limb is used prematurely, the fracture in its original position will be deformed, and the deformity will eventually heal. It takes a long time for the fracture to heal from the bone, so there is a gradual process for the intensity and time of functional training. Neither lead nor lag. Scientific choices should be made based on the location, extent, age of the patient's fracture, and the method of restoration and fixation. The transition from non-use sports to normal use after a fracture should have three conditions: (1) bone healing; (2) sufficient muscle strength; and (3) a certain range of joint ROM. The purpose of rehabilitation is to eliminate the remaining swelling, soften and stretch the fibrous tissue, increase the range of joint movement, strengthen muscle strength and dexterity of training muscles.

(1) Exercise therapy

Exercise therapy (7 photos)

1) Joint mobility training

a. Boost active exercise

After the restriction is lifted, it is difficult for the limbs to move autonomously. Power-assisted exercise can be used. With the improvement of joint mobility in the future, the power can be reduced (Figure 4).

b. Active movement: The involved joints carry out active activities in the direction of each axis of movement, including swing training and stretch training. Exercise amplitude should be gradually increased, within the patient's tolerance range, about 30 minutes each time, several times a day. Sometimes in order to improve the treatment effect, it is advisable to do it every hour for 5 to 10 minutes each time. The knee joint is actively moved as shown in FIG. 5.

c. Passive exercise: For those with severe contracture and adhesion, which cause inactive and assisted exercise to be ineffective, passive pulling or joint loosening technology can be used to loosen stiff joints, but the pulling should be smooth and gentle and should not cause obvious Pain and swelling. Avoid violence to avoid new tissue damage.

Methods are as follows: joint continuous passive motion (CPM) is shown in Figure 6. Manual treatment. Traction therapy. Continuous traction in the prone position as shown in FIG. 7.

2) muscle strengthening training

a, muscle strengthening exercise

• Passive exercise: used when muscle strength assessment is grade 0-1

• Boost active exercise: used when muscle strength assessment is grade 1 or 2

• Active exercise: Active exercise training begins when you return to level 3 muscle strength.

• Resistance exercise: used when muscle strength assessment is grade 4-5

b. Isometric exercise: Isometric exercise is required during the period required to maintain postoperative position. Isometric muscle training is shown in Figure 8.

c. Isotonic exercise: With the expansion of joint motion and active movement, isotonic exercise begins. As shown in Figure 9, the hip abduction resistance exercise resists hip abduction under elastic band tension to enhance muscle strength.

d. Isokinetic exercise: Dynamic training makes the muscle strength increase rapidly. Isokinetic exercise can further strengthen the muscle strength. Common training speeds are contraction rates of 60 ° / s, 120 ° / s and 180 ° / s. As shown in Fig. 10, the isokinetic exercise is strengthened.

(2) Physical therapy

• Local ultraviolet irradiation can promote calcium salt deposition and analgesia;

• Wax therapy, infrared, short wave, and heat compress can promote blood circulation, soften fibrous scar tissue, improve joint mobility, and can be used as auxiliary treatment before manual treatment

• Ultrasound therapy, audio electrotherapy, ultrasound-medium frequency electrotherapy, iodine ion introduction can soften scars and release adhesions. It can be flexibly selected according to the condition.

• For the treatment of delayed fracture healing and fracture nonunion, DC cathodic electrical stimulation treatment, ultrasound stimulation treatment and extracorporeal shock wave treatment can also be adopted.

(3) Occupational therapy: According to the specific dysfunction of fracture patients, from the activities of daily life, manual labor and cultural and physical activities, select some operations that help to restore the function and skills of the affected limb for treatment. In order to improve motor skills and enhance physical fitness, the patient's ADL and work ability can be restored before injury.