The turning point
is called a complete or partial violation of the integrity of the bone. Depending on how damaged the skin is, fractures are divided into closed and open.
For broken bones
the following phenomena are observed: pain, bruising and deformities, shortening of the limb, abnormal mobility, bone crepitus, and most importantly, a dysfunction that occurs immediately after injury. Among other things, any fracture is accompanied by trauma to adjacent tissues, edema, hematomas, often muscles, ligaments, joint capsule, etc. are damaged.
It should be noted that no one is safe from fractures and injuries of the upper limbs. And if such a situation has arisen, then you should immediately contact a traumatologist. The doctor will apply a cast. If the case is severe, then the treatment can be very long, there may even be a surgical intervention.
Treatment includes general and local treatments. In order to achieve correct fusion of bones in a fracture, it is necessary to place the fragments of the damaged bone in the desired position and hold them in this position until complete fusion. If the fracture is open, then the primary surgical debridement of the wound should be performed before immobilization.
For the normal healing of the fracture in the shortest possible time, it is necessary that the fixation of the repositioned fragments be strong and reliable. In order to achieve immobility at the fracture site, it is necessary to provide this place with a plaster cast, as well as constant traction, osteosynthesis or compression-distraction devices.
In order to restore the functions of the limb, as well as the patient's ability to work, functional methods of treatment are used, such as Exercise therapy with a fracture of the upper limbs, exercise on simulators, exercises that contribute to tension and stretching of the muscles. Therapeutic gymnastics for fractures of the upper extremities, massage, physiotherapy and hydrotherapy are also widely used. If physiotherapy is used in the early stages of treatment, it will help to eliminate symptoms such as pain, swelling, hemorrhage, etc. Among other things, physiotherapy accelerates the formation of calluses, restores the function of the limb, and also prevents postoperative complications.
On the second or third day after the fracture, UHF or inductothermy is prescribed, UV irradiation, laser therapy, electrophoresis with calcium and phosphorus, massage, as well as physiotherapy exercises for injuries of the upper extremities.
If muscle atrophy occurs, in such cases it is necessary to resort to the help of electrical stimulation (with the preliminary introduction of ATP), vibration massage, stretching exercises, isometric exercises, training on simulators, running and gymnastics in the water, swimming, cycling, walking are also necessary skiing, various games.
In the presence of joint contractures, doctors recommend electrophoresis with lidase, phonophoresis with lazonil, arthrosenex, mobilat, as well as LH for fractures of the upper limbs, which is carried out in water. Patients are shown exercises on simulators, cryomassage, sauna and swimming in the pool.
In the presence of a plaster cast or apparatus for compression osteosynthesis, such as the Ilizarov-Gudushauri, Dedova, Volkov-Oganesyan apparatus, etc. Moreover, from the first days of injury, exercise therapy for healthy limbs is included in the treatment process, which includes breathing exercises, general developmental and isometric exercises, stretching ...
After the plaster cast and the apparatus are removed, the patient is advised to walk, and the use of axial load on the limb is also of no small importance.
In case of fractures of the bones of the upper limb, PH is included in the rehabilitation process for injuries of the upper limbs, which helps to prevent contractures and stiffness of the joints of the fingers, as well as to preserve the ability to grip. After the plaster cast is removed, massage and occupational therapy of the injured limb are included, exercises that contribute to the acquisition of self-care skills are especially important.
Physiotherapy exercises and remedial gymnastics for fractures and injuries of the upper extremities are aimed at restoring the full range of motion in the joints, strengthening muscles. Very often exercise therapy for injuries of the upper extremities is prescribed to the patient immediately from the first days after injury. Moreover, first, light exercises are used, the tasks of which include reducing swelling and bruising, as well as improving blood circulation. Later, exercises that help strengthen the muscles are added to the complex of exercise therapy and LH in case of a fracture of the upper extremities. Then, exercises with resistance, weights and using various objects are gradually included.
A set of exerciseswith a fracture of the upper limbs
(very important - when performing these exercises, make sure that there is no pain in the injured hand):
Starting position - standing or sitting.
1. Perform circular movements with the shoulders, while shaking the sore arm. Raise your shoulders up.
2. Bend your arms at the elbows with tension, perform circular movements in the shoulder joint.
3. Raise your arms up through the sides, then lower. Raise your arms forward and up, lower.
4. Put the sore hand on the healthy one, raise two hands up.
5. Perform a movement imitating chopping wood, from the shoulder of the sore arm to the opposite knee.
6. Raise the sore hand up, stroke the hair.
7. Raise the sore arm up and touch the opposite shoulder.
8. Fold your hands into a "lock", straighten your arms forward.
9. Bend your arms at the elbows. Then touch the shoulders with your hands, while bringing your elbows together.
10. Lower your arms along the body. Perform sliding movements with your hands up to the armpits along the lateral surface of the body.
11. With straight hands, do clap, first in front of you, and then behind you.
12. Perform circular movements with straight, relaxed arms.
Next set of exercises for upper limb injury
performed from a standing position, holding a gymnastic stick in your hands:
1. Raise straight arms with a stick up.
2. Take a stick in one hand, extend your hand with the stick in front of you (the stick is in an upright position). Shift the stick from one hand to the other, while with your free hand perform movements to the side, up and in front of you.
3. Put the stick with one end on the floor, holding the other end with the sore hand, perform the movements with the stick, like a lever.
4. Hold the stick in front of you with both arms extended forward and perform circular motions.
5. Put your hands down, holding a stick. Perform the movement of the "pendulum" in one direction and the other.
6. Hold the stick in front of you with outstretched arms. The brushes should be brought together. Twirl the stick in your hands like a "mill", while fingering with your fingers.
7. With a sick hand, take a stick and make it back and forth (movements imitating a steam locomotive).
Lying position
1. I. p. - lying on his back, a healthy hand brought under the patient, flexion of the arms in the shoulder joints (4-5 times).
2. I. p. - lying on his back, arms bent at the elbow joints, with support on the elbows, slight bending in the thoracic spine with the shoulders dilating at the same time - inhale, return to and. p. - exhale (3-4 times).
3. I. p. - lying on your back, the sore arm rests on the plastic panel. Abduction of a straight arm on a polished surface with a horizontal position and an inclined position of the panel (4-6 times).
This material will describe the rehabilitation process for injuries of the upper limbs. In this process, physiotherapy exercises for children and adults is an obligatory component of treatment, since it helps to restore the functioning of the musculoskeletal system. Exercises can be prescribed from the very first days of injury, if severe pain is not observed. Physical therapy should not be used if the patient has severe blood loss, shock, risk of bleeding, or persistent pain.
Let us analyze the complex of exercises in physiotherapy exercises for injuries of the upper extremities for bedridden patients:
1. Raise your hand in two counts while inhaling. Also omit it by two counts. Exhale. At a slow pace, repeat the exercise at least three times.
2. Place your hand on your shoulder. Slowly make a circular rotation with your shoulder. Without increasing speed, do 4 times. At the same time, inhale in the first semicircle and exhale in the second.
3. Slowly, in two counts, tilt your head up. Take a breath. Exhaling, tilt your head down in two counts.
4. Bend your elbow in two counts. Breathe freely and do the exercise 6 to 8 times.
5. Take turns slowly bending your knees. Breathe freely.
6. Perform a breathing exercise: for two counts, inhaling, move your arm to the side. Slowly return to the starting position while exhaling.
7. Turn your head to the right in two counts. Return to starting position slowly. Do the same on the other side. Repeat from the beginning.
8. Raise your leg in two counts - inhale. At the same rate, lower - exhale. Repeat five times. Do the same on the other leg.
9. While exhaling, lean on your good arm and legs, bent at the knees. Raise your pelvis in two counts. On the next two, lower it, accompanying the exhalation.
10. Rotate your legs alternately, each in four counts.
11. Repeat the breathing exercise: for two counts, while inhaling, move your arm to the side. Slowly return to the starting position while exhaling.
12. Bend and unbend your feet in four counts.
13. Finish with a breathing exercise.
Physiotherapy exercises for osteochondrosis, hernias, fractures, scoliosis, arthrosis, flat feet shows itself to be extremely effective. At the same time, it is important to know the contraindications to its use and to use other methods of treatment in combination.
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Exercise therapy for bone injuries
For bone injuries in the first period tasks of exercise therapy are:
1) prevention of the consequences of trauma and immobilization, in particular, atrophy and contractures;
2) stimulation of regeneration;
3) prevention of possible complications associated with the need to maintain forced postures for a long time, which is especially important in skeletal traction;
4) maintaining the required level of functioning of various systems and the body as a whole.
The solution of the first two tasks - prevention of the consequences of trauma and immobilization and stimulation of regeneration - is unambiguous in terms of the selection of funds, although methodologically they have certain differences.
In the first period, the remedies used for exercise therapy are mainly determined by the need to increase blood flow to the site of injury. For this, the complex includes exercises that involve all the non-immobilized joints of the injured limb in movement. It should be remembered that any muscle activity in the period immediately following the injury should not disturb the position of the immobilized fragments and cause their displacement in order to provide optimal conditions for fracture healing. Particular attention is paid to exercises on the joints distal relative to the immobilized area: increased blood flow to them necessarily passes through the damaged area, the tissues of which can take advantage of this, taking the nutrients and oxygen they need from the blood and giving metabolic products there. The muscles directly in immobilization and the nearest joints of the injured area cannot be active, therefore, a whole range of other special means can be used: static tension, sending impulses, ideomotor exercises, etc. They not only increase blood flow here, but also activate regeneration, stimulating processes synthesis of cellular elements.
In the first period, exercises along the axis of the limb are extremely effective - irritation of the receptors located in the area of juxtaposition of the fragments is a strong stimulator of the synthesis of bone tissue cells, which noticeably accelerates regeneration. However, in the application of axial loads, one must be very careful so that they do not lead to displacement of the juxtaposed bone fragments.
In addition to physical exercises, to solve the problems of preventing the consequences of immobilization and stimulating regeneration, it is effective to use massage. If access to the site of injury is possible (for example, with skeletal traction or when applying the Ilizarov apparatus), then the main attention is paid to this area, mainly using stroking and superficial rubbing techniques. In this case, the masseur should be especially careful not to allow the displacement of bone fragments. When applying a plaster cast, distal and proximal parts of the body or extremities directly adjacent to the injury site are massaged. In addition, elements of vibration massage can be used by, for example, tapping directly on a cast in the area of injury.
To prevent the development of contractures (joint stiffness), not only active exercises performed by the patient himself can be used, but also passive ones performed both with the help of another person and by the patient himself at the expense of healthy limbs.
The solution to the problem of preventing possible complications associated with the need for long-term maintenance of forced postures is especially important for patients undergoing skeletal traction or with an imposed plaster cast. Most often, such complications consist in the formation of pressure ulcers and in the development of pneumonia. Both disorders are the result of stagnation, respectively, in the skin and subcutaneous tissue of the body parts that are in contact with the support or plaster for a long time (with pressure ulcers) and in the areas of the lobes of the lungs that are poorly ventilated due to the forced posture, most often these are the lower lobes (with pneumonia). To prevent the formation of pressure ulcers, massage of the corresponding parts of the body is of particular importance. The focus is on deep rubbing. In addition, it is important to teach the patient household skills and special movements aimed at changing the position of the body: turning in bed, raising the pelvis, walking with crutches, etc. But household loads require special care, otherwise they can adversely affect the course of the regenerative process in the damaged bone.
To prevent the development of pneumonia (pneumonia) in patients with skeletal traction (especially often in the elderly), breathing exercises are most effective: diaphragmatic breathing, full breathing of yogis, Strelnikova's breathing exercises, etc.
In addition to the noted disorders, the injured often have unfavorable changes associated with intestinal atony - constipation, flatulence, etc. These disorders are mainly associated with a decrease in the activity of the muscles of the trunk and abdominal muscles. Therefore, in the patient's motor regime, it is imperative to include exercises aimed at the predominant rhythmic activity of the muscles surrounding the abdominal cavity and adjacent straight, oblique and transverse abdominal muscles, perineal muscles, buttocks. Particular attention should be paid to the work of the diaphragm, contractions and relaxation of which not only activate the patient's breathing, but also perform a kind of massage of the abdominal organs.
The exercise therapy regimen in the first period should provide for repeated exercises during the day, alternating with massage and with means of active rest. For this, it is necessary that a certain part of the exercises the patient performs independently after his preliminary training by a specialist in exercise therapy; These are exercises for distal muscle groups, static, breathing exercises, self-massage elements, etc.
Second period Exercise therapy ( postimmobilization) in case of bone injuries, it begins with the formation of the so-called "soft callus" and the removal of immobilization. His tasks are:
1) elimination of contractures and atrophy;
2) further stimulation of regeneration;
3) increasing the functional state of the body.
In the period of postimmobilization, the effect of physical exercises should ensure the structural reorganization of the callus in accordance with the requirements of the function. To do this, it is necessary to actively include the damaged segment in the exercise specific to it. These tasks are solved with the help of active movements in all joints of the injured limb, treatment by position, static muscle tension in performing a variety of everyday tasks.
In the second period, much attention is paid to the elimination of contractures in the joints that have undergone immobilization, and the normalization of the functional state of the neuromuscular apparatus. For these purposes, in addition to active movements that increase mobility in the joints, posture treatment, exercises performed in lightened positions are used. Training the strength and endurance of hypotrophied muscles should be carried out taking into account their functional capabilities, however, with the obligatory condition of a gradual increase in the load. The mode of increasing the load, as in the case of soft tissue injuries, is determined in such a way when an increase in the duration of the exercises alternates in succession, then the strength of the performance, then again the duration, etc.
Exercise therapy means in the second period become more diverse. In addition to gymnastic exercises, mechanotherapy, exercises on block apparatus, targeted occupational therapy, etc. are used.
Massage continues to be of great importance. When performing it, special attention is paid to kneading, which becomes more and more deep, shock techniques and various vibration options.
V third period Exercise therapy tasks are solved:
1) acceleration of the completion of the fracture consolidation processes and the formation of a full-fledged bone structure;
2) restoration of motor and coordination abilities of the injured person.
The main goal of this period is to prepare the patient for muscle tensions inherent in a healthy body, which is a necessary condition for his adaptation to household, industrial (and for athletes - to sports) loads. This problem is solved mainly with the help of exercises of a general physical nature, as well as with the inclusion of elements of some types of sports exercises (sports and applied sports, sports games, skiing, running, jumping, etc.). Methodologically, attention should be paid to the following circumstances:
On the formation of a patient's reliable attitude to regular physical education with a gradual increase in the load;
Predicting everyday behavior aimed at preventing injury.
Physiotherapy exercises have certain specific features for injuries to various bones.
At fractures of the tubular bones of the extremities a plaster cast fixes the joints above and below the fracture. When fixing the same limb by skeletal traction (more often used for fractures of the lower extremities), the weight used is reduced as the bone fragments are compared.
Therapeutic physical training for diaphyseal fractures of the bones of the upper and lower extremities has a lot in common.
V first period classes begin immediately after acute pain subsides, gypsum dries up or other types of immobilization are fixed. Exercise, along with a general tonic effect and prevention of various complications (pneumonia, deterioration of intestinal motility, vein thrombosis), accelerate the processes of resorption of hemorrhage and callus formation, prevent muscle atrophy and joint stiffness.
At fracture of the diaphysis of the shoulder or forearm in the first period, when applying a plaster cast, various finger movements are performed: flexion and extension, dilution and reduction, contrasting fingers. At first, these exercises are performed freely, and then with overcoming resistance: squeezing the ball, sponge, stretching the rubber bandage. They alternate with exercises for healthy limbs, trunk and breathing exercises. Exercises for a healthy hand are widely used. In addition to gymnastic exercises, walking is included in the lesson. In case of forearm fractures, these exercises are supplemented with movements along all axes of the shoulder joint, first with the help of a healthy hand, then without its help. The muscles under the plaster are exercised in static tension, followed by relaxation, as well as using ideomotor exercises. In those cases when, with a shoulder fracture, the hand is on the abduction splint, along with the indicated ones, various movements are performed in the wrist and elbow joints (movements in the elbow joint are carried out at an incomplete amplitude).
At fracture of the diaphysis of the thigh or lower leg in the case of the application of plaster in the first period of the injured limb, active movements are performed in the joints free from plaster. With a fracture of the hip, this can be movements of the toes, with a fracture of the lower leg - movements in the hip joint, first with the help, and then independently. Exercises in rhythmic static muscle tension under a plaster cast are also used: three to five seconds of tension and the same time for relaxation. Quite effective in this period is the exercise "playing with the patella" with isotonic contraction of the rectus head of the quadriceps femoris muscle; this exercise can be done multiple times throughout the day. Active movements alternate with sending impulses to immobilized muscles and with ideomotor exercises.
At broken leg bones in the case of a good comparison of the fragments, the axial load is carried out first by pressing the injured limb on the arm of the exercise therapy specialist or on the back of the bed, and then - when they start on the injured leg while walking with crutches. Physical exercise in the form of therapeutic walking is a natural biological method that ensures tight contact and compression of bone fragments. In the earlier stages of the patient's treatment, i.e. when he is still not walking, tight contact and compression of the bone fragments can be provided with the help of isometric tension of the muscles-antagonists of the damaged segment.
At hip fractures the axial load is resorted to only in the second period.
At shaft fractures bones of the thigh and lower leg at the beginning of the first period, the exercises are performed in the initial lying position, and then sequentially sitting, standing and walking with crutches.
When preparing to walk with crutches, you should pay attention to the training of the muscles of the shoulder girdle and upper limbs, which will bear a compensatory load during walking. For this, various weights can be used, and the exercise regimen should provide an increase in strength. While learning to walk with crutches, attention is drawn to the correct positioning of the leg (from the heel straight in front of him), otherwise, as a result of the “sparing effect” of the injured limb that occurs in the patient during the first attempts to walk, the wrong walking skill may become entrenched, which will then be difficult to alter.
In addition to special exercises for the diseased limb, exercises for healthy limbs and trunk are used, as well as breathing exercises: chest, diaphragmatic and full breathing with an extended exhalation.
When treating fractures of the diaphysis of the bones of the lower extremities by skeletal traction, the same special exercises are used as when applying a plaster cast. However, in this period, one should not forget about such consequences of prolonged forced lying posture as bedsores and pneumonia. Therefore, general toning exercises are widely used, as well as raising the pelvis, turning the torso and various options for breathing exercises. These movements are complemented by massage and self-massage.
For all types of limb injuries, the intensity and repetition of the loads depend on the patient's condition, but the total volume of the load should gradually increase in such a way that the duration of the lesson increases and the repeatability of the complex decreases. Such a regime is achieved due to the repeated self-administration of medical complexes by the patient during the day.
In second period exercises with the aim of general tonic action continue to be applied. Thanks to them:
The muscles of the injured limb are strengthened;
Increases (with the help of active and passive exercises) mobility in joints that have been motionless for a long time;
Callus is strengthened with the help of exercises that cause axial load on the limb;
The venous outflow of blood improves and swelling decreases with the help of movements in the small joints of the limb;
Motor acts are restored - the patient begins to walk, etc.
In the second period at fractures of the diaphysis of the bones of the shoulder or forearm with the injured hand, exercises are performed for the fingers of the hand, which were used in the first period, movements in the elbow joint from the initial sitting positions, the hand lies on the table, and then standing: flexion and extension, supination and pronation. More and more, the shoulder joint is included in the movements: flexion and extension, abduction and adduction, circular movements and rotation. They are carried out from the initial sitting and standing positions with an inclination towards the injured arm (Fig. 19). Passive movements are widely used when exercises for an injured hand are performed with the help of a healthy one. Exercises to relax the muscles of the injured limb are included.
Rice. 19. Exercising the shoulder joint in a tilted position
Various equipment and implements are used to perform the exercises: dumbbells, rubber bandages, resistance bands, gymnastic sticks, balls, etc. It is desirable to use elements of occupational therapy, in particular those where the injured hand is involved in movements associated with self-service.
At fractures of the bones of the thigh and lower leg in the second period, regardless of the method of immobilization adopted in the first period, exercises are used to strengthen the muscles of the injured limb and increase the mobility in the joints. Initially, the exercises are performed in the supine and seated positions without full load on the injured leg. The axial load on the leg increases gradually. The patient trains in walking with crutches, gradually loading the injured limb more and more with body weight. However, it should be remembered that the load on the injured leg should not cause pain. Gradually, already in the second period, the patient begins to walk with support on a stick.
Strength training of the muscles of the lower extremities is of great importance in the second period. For this, various simulators and other equipment and inventory are used. It turns out to be effective for these purposes and the use of their body weight, for example, squats at the gymnastic wall in a mixed hang, and then with full load. To restore joint mobility, first of all, multiple repetitions of movements in them are used without burdens, but with a gradually increasing amplitude. For the same purposes, passive exercises (with the help of other people or healthy limbs) and mechanotherapy are used. Already from the middle of the second period, the patient learns to walk without a cane, with full load on the injured leg.
All special exercises are performed with a gradually increasing load. This effect is achieved not only by an increase in resistance or the number of repetitions of exercises, but also by a gradual complication of both the exercises themselves and the starting positions in which they are performed.
In the second period, they continue to use general developmental exercises with a gradually increasing load for healthy limbs and trunk. A good effect in this regard is achieved by exercising in the water.
V third period with the help of physical exercises, a complete restoration of all body functions is achieved, a person's adaptation to everyday and industrial loads, and the improvement of all functions of the injured limb.
Along with the exercises of the second period, various sports and applied exercises are used; occupational therapy is gaining in importance. So, to improve supination and pronation of the hand, you can use screwing in and out with a screwdriver bolts, to increase flexion-extension and muscle strength - a file or work with a plane. In the third period, exercises from the second period continue to be used, aimed at full restoration of the functions of the injured limb, muscle strength, joint mobility, coordination of movements and motor skills.
Trauma to the lower extremity, as a rule, is accompanied by a sharp violation of muscle tone, musculo-articular feeling, coordination of movements and other indicators of limb function. The normalization of these changes noticeably lags behind the regeneration of bone tissue - sometimes they remain unrepaired even one to two years after the fracture has healed, which explains the need to continue exercise therapy for the specified time.
Trauma is a sudden impact on the human body of environmental factors (mechanical, physical, chemical, etc.), leading to a violation of the anatomical integrity of tissues and functional disorders in them.
There are the following types of injuries: industrial, household, street, transport, sports and military.
The most common injuries of the musculoskeletal system as a result of mechanical force: bone fractures, sprains and ruptures of muscles or ligaments, dislocations.
With a slight effect of the damaging factor, local symptoms of trauma predominate: redness, swelling, pain, dysfunction. With extensive damage, along with local symptoms, there are disturbances in the activity of the central nervous, cardiovascular and respiratory systems, gastrointestinal tract, excretory organs and endocrine glands.
The totality of general and local pathological changes that occur in the body after an injury is called traumatic illness.
Common manifestations of traumatic illness are: fainting, collapse, traumatic shock.
Fainting is a short-term loss of consciousness caused by insufficient blood circulation in the brain (as a result of a reflex spasm of its vessels). When fainting, dizziness, nausea, ringing in the ears, cold extremities, a sharp blanching of the skin, and a decrease in blood pressure are observed.
Collapse is a form of acute vascular insufficiency (associated with blood loss, pain, anesthesia, intoxication.) It is characterized by a weakening of cardiac activity as a result of a decrease in vascular tone or circulating blood mass, which leads to a decrease in venous blood flow to the heart, a decrease in blood pressure and brain hypoxia. Collapse symptoms: general weakness, dizziness, cold sweat; consciousness is preserved or clouded.
Traumatic shock is a severe pathological process that occurs in the body as a response to severe trauma. It is manifested by an increasing suppression of vital functions due to a violation of nervous and hormonal regulation, the activity of the cardiovascular, respiratory, excretory and other systems of the body.
Traumatic injuries of ODA, in which exercise therapy is used, include bone fractures, tissue damage (muscles, ligaments, tendons), joint bruises, dislocations.
Fracture is a complete violation of the anatomical integrity of the bone caused by violence (mechanical impact) exceeding the limits of its strength and accompanied by damage to the surrounding tissues and dysfunction of the damaged segment of the body.
Fracture symptoms:
dysfunction
limb deformation and shortening
abnormal mobility
crepitus (friction of one fragment against another)
sometimes there is a shock
Depending on the origin, bone fractures are divided into:
Congenital, arising in the prenatal period, due to the inferiority of the bone skeleton of the fetus.
Acquired, which in turn are divided into: traumatic, arising under the influence of mechanical factors. Pathological, resulting from a pathological process in the bones (tumors, osteomyelitis, tuberculosis).
There are open fractures, accompanied by damage to the skin (if there is an external wound), and closed, when the integrity of the skin is preserved (if there is no external wound). Open fractures are more severe because blood is poured out and there is an open gate for infection.
Depending on the localization, fractures of tubular bones are divided into epiphyseal (intraarticular)
metaphyseal (periarticular)
diaphyseal (the entire length of the bone).
They are divided into upper, middle and lower third.
Intra-articular fractures are the most severe and are divided into:
fractures with preservation of the congruence of the articular surfaces;
fractures with a violation of the congruence of the articular surfaces;
comminuted fractures, dangerous loss of mobility in the joint;
fractures-dislocations.
Depending on the mechanism of origin, fractures are divided
compression fractures
flexion fractures
torsion fractures
avulsion fractures
In the direction of the fracture lines (with respect to the axis of the bone), there are
transverse
longitudinal
helical (spiral)
If the bone is damaged with the formation of fragments, then comminuted fractures occur.
When a large number of small bone fragments are formed, fractures are called fragmented.
Under the influence of external force and subsequent traction of the muscles, most fractures are accompanied by the displacement of fragments.
In children, bone fractures occur as a green branch, i.e. bone fragments are held by the intact periosteum as in a sheath.
Fractures of one segment or one area are called isolated.
Injuries of several localizations of the support and movement organs (fracture of the hip and lower leg, shoulder and thigh, etc.) are called multiple.
Injuries of several different systems and organs (hip fracture with ruptured spleen) are called combined.
First aid for fractures:
anesthesia (using a syringe tube)
stopping bleeding (using a tourniquet and improvised means)
immobilization (using a splint)
if breathing stops - artificial respiration
in case of cardiac arrest - closed heart massage
referral to hospital
Fracture treatment includes restoration of the anatomical integrity of the fractured bone and the function of the damaged segment. The solution to these tasks is achieved through:
early and accurate matching of fragments (reduction)
firm fixation of the repositioned fragments - until they are completely fused
timely functional treatment
Fracture treatment methods:
The conservative method is divided into 2 stages - fixation and traction. Fixation means can be plaster casts, braces, corsets and other devices. To achieve immobility and rest of the injured limb, a plaster cast fixes 2-3 nearby joints.
Skeletal traction is used in the treatment of displaced fractures, oblique, helical and comminuted fractures of long bones, some fractures of the pelvis, upper cervical vertebrae, bones in the ankle and calcaneus. Currently, the most common traction is with the Kirschner wire, which is stretched in a special bracket. A load is attached to the bracket with a cord. After removing the skeletal traction, a plaster cast is applied after 20-50 days.
Operational method:
- A) metal osteosynthesis - connection of bone fragments using metal structures (knitting needles, nails, wire, etc.)
- B) the imposition of the Ilizarov, Volkov compression-distraction apparatuses ... (the crossing needles are passed through the bone, connected with rings, and the rings with barbells.)
The advantage of the surgical method of treatment is that after fixation of the fragments, movements can be made in all joints of the damaged segment of the body, which cannot be done with a plaster cast (the patient can serve himself from the first days).
Restorative method - exercise therapy, massage, occupational therapy, mechanotherapy, physiotherapy, acupuncture and manual therapy.
Complications in the treatment of fractures:
congestive pneumonia
contracture - limitation of mobility in the joints
ankylosis - complete lack of mobility in the joint
muscle wasting - a decrease in muscle volume
amyotrophy
Exercise therapy periods for injuries:
immobilization or period of emergency
post-immobilization
restorative
The first period corresponds to bone fusion of fragments, which occurs on average 30-90 days after injury.
LH is prescribed from the first days of the patient's admission to the hospital.
Exercise therapy tasks:
- -normalization of the patient's psychoemotional state;
- -improvement of metabolism, activity of the cardiovascular and respiratory systems, excretory organs;
- - prevention of complications (congestive pneumonia, flatulence, etc.).
- -acceleration of resorption of hemorrhage and edema;
- -acceleration of the formation of callus (with fractures);
- -improvement of the process of regeneration of damaged tissues;
- -Prevention of muscle atrophy, contractures and joint stiffness.
Contraindications to exercise therapy: general serious condition of the patient, persistent pain syndrome, the presence of foreign bodies in the tissues.
Exercise therapy means:
- -ORU (for non-injured body parts);
- - breathing exercises: for bedridden patients - in a ratio of 1: 1; for walking - 1: 2 (3);
active FU for joints free from immobilization;
ex. for the abdominal muscles in isometric mode and the muscles of those parts of the body where pressure sores can form;
position treatment;
ideomotor exercises;
isometric muscle tension under immobilization.
The second period (post-immobilization) begins after the removal of the plaster cast or traction. The patients developed primary callus, but in most cases the muscle strength is reduced, the range of motion in the joints of the immobilized limb is limited.
Exercise therapy tasks:
strengthening callus
during surgery - ensuring the mobility of the scar, not welded to the underlying tissues;
completion of the processes of regeneration of damaged tissues and restoration of functions in the area of damage;
further prevention of muscle atrophy and joint contractures;
strengthening the muscles of the shoulder girdle, trunk and limbs.
Exercise therapy means:
Breathing exercises
Passive and then active exercises for the joints of the affected body part
Corrective exercises
Exercise in balance
Static controls
Exercise in muscle relaxation
Exercise with items.
Exercises in the beginning are best performed from lightened starting positions (lying, sitting).
Active movements aimed at restoring mobility in the joints alternate with exercises that help both strengthen and relax muscles.
The third period (recovery) - in patients, residual effects are possible in the form of insufficiency or limitation of the range of motion in the joints, a decrease in the strength and endurance of the muscles of the injured limb.
It takes place in a rehabilitation center, or in a sanatorium, or in a polyclinic at the place of residence (partly at home).
Exercise therapy tasks:
final (if possible) restoration of functions;
adaptation of the body to everyday and industrial loads;
formation of compensations, new motor skills.
Exercise therapy means:
applied sports exercises
training on simulators
natural factors of nature
The total physical activity increases due to the duration and density of the procedure, the number of exercises. and their repeatability, different starting positions. ORU is supplemented with dosed walking, therapeutic swimming, applied exercises, mechanotherapy. Occupational therapy is also widely used during this period.
Exercise therapy is widely used in traumatology. Trauma forces the patient to lie motionless for a long time on his back, on his stomach, on an inclined plane, in a hammock, etc., which can cause congestion, the formation of bedsores, constipation, interfering with treatment. The tasks of exercise therapy are: improving the general condition of the patient, as well as blood and lymph circulation, promoting the rapid resorption of edema and hematoma, restoring the function of the damaged organ, developing replacement movements with the loss of basic movement, preventing the development of contractures.
General principles
The set of exercises begins with the joints not captured by immobilization, gradually including exercises for the joints near the injury site. Often exercises are performed with a symmetrical joint of a healthy limb, which reflexively affects the affected one. The complex includes general strengthening and special exercises. Exercise therapy is combined with physiotherapy procedures, massage, which usually precede exercise therapy classes. When using special exercises, the instructor first makes passive movements, then the severity of the limb itself (relaxation exercise) is used, and only later the patient switches to active movements, complicating them with exercises with shells. The entire treatment course is conventionally divided into 3 periods. The first period from the moment of injury to the entire time of immobilization (skeletal traction, plaster cast, surgical interventions).
The tasks of exercise therapy in this period - improving the general condition of the patient, combating congestion, preventing the formation of stiffness in joints free from immobilization, promoting healing processes, increasing blood and lymph circulation.
The second period - almost complete restoration of the integrity of the damaged organ, replacement of the circular plaster immobilization with a removable splint. The task of exercise therapy in this period is to restore the normal range of motion in all joints, improve the function of the damaged organ (start with simple exercises, gradually expanding the range of motion and increasing the total load, developing new substitution skills if necessary).
The third period is the presence of residual trauma (muscle weakness, slight dysfunction).
The main tasks of exercise therapy - the elimination of all residual phenomena, the restoration of the necessary household and work skills, the development of endurance, speed, strength, accuracy of movements, etc. The set of exercises includes more complex gymnastic exercises and a number of applied exercises that prepare for work.
Exercise therapy for limb injuries
When treating fractures of the bones of the hand and fingers, exercise therapy begins on the 2-3rd day. The movements are performed in the joints of the injured limb free from immobilization. With fractures of the metacarpal bones, attention is paid to pinching and spreading the fingers. In case of fractures of the fingers, after removing the splints, they make various movements with the fingers, especially with the damaged phalanges. In case of a fracture of the wrist after removing the plaster cast, exercises for the wrist-wrist joint are included - active movements in all directions with a slight emphasis on the hand, bringing and extending the fingers, bending and extending them, etc., without causing pain, then add exercises with sticks, medicine ball, clubs.
Forearm bone injury
In case of forearm bone injuries, active movements for the fingers are allowed, exercises for the shoulder joint of the injured hand at the beginning with the help of a healthy hand (raising the hand up, circular movements) For the damaged area, rhythmic muscle contractions are performed under the bandage several times a day. When the callus gets stronger, the plaster cast is replaced with a removable splint and the complex of exercises includes active exercises at a slow pace, passive exercises are added and, if necessary, exercises on apparatus. They also increase the overall load on the entire body, including general strengthening exercises at a faster pace.
Humerus fractures
In the first period, general strengthening exercises are used for the trunk and a healthy hand, exercises for the hand (flexion and extension of the fingers, raising the hand with straightened fingers, etc.).
Rice. 141. Exercises for fractures of the shoulder and forearm.
After removing the splint, exercises are performed in a lightweight starting position, exercises with the help of a gymnastic stick, which distracts the patient's attention from the injured limb and makes movements freer (Fig. 141).
Hip fracture
From the first days, general strengthening exercises are carried out for the shoulder girdle, a healthy leg, for the toes of the injured limb (extension and flexion of the foot 4-5 times), static stress under the bandage up to 10 times a day. In the future, they are allowed to raise a leg, turn on their stomach, get out of bed and, finally, walk on crutches. Before standing up, the armpits should be prepared for crutch pressure. After removing the cast or traction, active exercises begin in all joints.
With limited mobility, passive movements in these joints are included. It is important to pay attention to the development of correct walking. When shortening the limb, orthopedic shoes should be worn.
Fractures of the shin bones
From the first days, movements are performed with the foot, fingers, in the hip joint. The main task of exercise therapy is to restore the support function of the limb.
Exercise therapy is used after improving the condition, includes general toning exercises, exercises for a symmetrical healthy limb. As the wound heals, exercises are performed on the muscles of the damaged area.
Therapeutic gymnastics actively helps the normal development of scar tissue.
Exercise therapy for spinal fractures
In case of spinal fractures, the patient lies on his back, a wooden shield is placed under the mattress. With compression fractures of the vertebrae, the head end of the bed is raised by 20 cm (Fig. 142).
Rice. 142. The position of the patient on an inclined bed with straps.
They begin therapeutic exercises 3-4 days after the injury, including exercises for the limbs and breathing at the beginning. Gradually, the exercises complicate, increase the amplitude and strength of muscle tension, actively include exercises for the shoulder girdle, carefully train the extensors of the back (Fig. 143). For the pelvic girdle during this period, exercises with a heavy load are not carried out. If there are no contraindications, after 10-12 days, some of the exercises are performed in the initial position lying on the stomach (Fig. 144).
Rice. 143 Exercises for spinal fractures in the first days of classes.
Rice. 144 Exercises for spinal fractures used during the first month of training.
In the second month of treatment, the set of exercises includes exercises with significant muscle effort.
Exercises that develop the flexibility of the spine ("swallow", etc.) are carried out. (fig. 145). The tasks of exercise therapy in these patients are the development of a good muscle corset and the strengthening of the muscles and ligaments of the spine. The duration of the lesson in this period is 40-50 minutes with rest after each series of exercises. After 2 months, the patient is allowed to get up, after teaching him the correct transition from a prone position to a standing position, without bending his back, the patient should not sit down.
Rice. 145. Exercises for spinal fractures, used for 2-3 months of training.
Exercise therapy for fractures of the pelvic bones
In case of a fracture of the pelvic bones, it is important for the patient to give the correct position lying on his back, a roller is placed under the knee joints. Therapeutic exercises begin 3-4 days later. First, exercises are performed for the shoulder girdle and trunk muscles, and gentle movements with support are allowed for the legs. After 2 weeks, exercises for the legs with a large load are carried out, while the legs continue to lie on the roller. When the patient is allowed to get up (from 3 weeks after fractures without displacement and unilateral, up to 2 months with a fracture with displacement and bilateral), some of the exercises are done while standing (Fig. 146).
Rice. 146. Exercises for fractures of the pelvic bones.
Physiotherapy exercises for joint diseases
The goal of exercise therapy for joint diseases is to strengthen and improve the general condition of the patient, restore impaired mobility of the musculoskeletal system, improve the work of the cardiovascular, respiratory and other body systems. In the acute phase, rest is observed and exercise therapy is not used. In the subacute and chronic stages, they include careful movements for the affected joints without causing pain, muscle relaxation exercises, light massage, passive and active swinging movements, the initial position first lying down, then lying down and sitting. Mechanotherapy devices are widely used to help develop joint mobility.
To prepare the patient for subsequent walking with lesions of the joints of the legs, exercises are performed for the muscles of the back, quadriceps muscles, for the muscles of the shoulder girdle, then they include training in walking, develop a correct gait.
In rheumatic arthritis, therapeutic exercises are included 6 months after the acute symptoms subsided, given the presence of contraindications due to possible damage to the valvular apparatus of the heart. Start with exercise. at a slow pace and perform them without muscle effort, the number of repetitions is from 6-8 to 10-12. As the process subsides, exercises with gymnastic sticks, clubs, blocks, ladders ", etc., are widely included, which increases the range of motion, strengthens the muscles. Exercises are repeated up to 10 times during the day.
Combination of gymnastics with thermal and water procedures and massage is more effective in the classroom.
Physiotherapy exercises for spinal deformities
There are deformities of the spine in the anteroposterior (lordosis - forward curvature and kyphosis - backward curvature) and in the frontal (scoliosis - lateral curvature) plane. According to the form, scoliosis is divided into one-, two-, right- or left-sided, thoracic, lumbar, etc. (Fig. 147).
Rice. 147. Various forms of scoliosis.
I degree- a slight curvature of the spine, manifested by improper standing of the shoulder blades and shoulder girdle. With active straightening, scoliosis disappears, that is, the changes are of a functional nature.
II degree- changes in the spine are more pronounced. There is a counter-curvature and development of the rib hump. Active straightening does not correct the curvature. Hanging on the arms or on a Glisson loop (stretching the torso) straightens the spine. With this degree of scoliosis, there is a shortening of the ligaments and changes in the intervertebral cartilage.
The methodology of exercise therapy for I degree of scoliosis is the correct physical education in the family and at school. Children should exercise, swim on their chest, ski, play sports. For children with severe scoliosis, it is necessary to organize additional therapeutic exercises.
III degree- the presence of persistent anatomical changes in the spine, pronounced rib hump, deformed chest and spine. The changes involve bone tissue and the area of curvature is immobile.
The tasks of corrective gymnastics are: increasing the mobility of the spine, reducing or eliminating its curvatures, strengthening the muscles and ensuring the normal inclination of the pelvis, as well as the possible elimination of deficiencies in the structure of the body associated with curvature of the spine, and consolidating the results of correction.
Exercise complexes consist of gymnastic exercises in the initial lying position, sitting, standing on all fours, hanging, etc. Exercises are used with and without objects, on apparatus, exercises in stretching the spine on an inclined plane, a gymnastic wall, in a Glisson loop, exercises in bending the spine in places of curvature with support on a roller, medicine ball, exercises in balance with a weight on the head.
Corrective exercises must be combined with general strengthening and breathing exercises.
With scoliosis of the II degree, exercise therapy includes general strengthening exercises, exercises for strength endurance, balance, resistance, as well as special exercises for posture. They do exercises with gymnastic sticks, balls, clubs, exercises on a gymnastic wall, rings, bench. Starting positions often change: lying on your stomach, back, on your side, on all fours. Treatment should be persistent and long-term (at least 6 months) and it is carried out 3 times a week.
At home, you should do an independent set of exercises daily.
Preventive measures are of great importance: correct sitting at the desk, appropriate furniture, hard bed (shield under a cotton mattress).
Physiotherapy exercises for flat feet
With flat feet, when the inner arch of the foot is lowered and the pronation of the foot is increased, therapeutic exercises take the leading place in treatment, which strengthens the muscles and ligaments that support the arch, has a corrective effect on the faulty position of the feet, toes and the depth of the arches.
Therapeutic exercises are carried out in the initial lying position, sitting, and then in walking. In the initial lying position. and while sitting, supination of the foot, grasping of various objects (balls, sticks) with the toes, walking with support on the outer edge of the foot, walking on an oblique surface, walking barefoot on loose soil, sand, climbing a pole and rope with the inner side of the feet.
Physiotherapy exercises for amputations and the method of preparing the stump for prosthetics
The tasks of exercise therapy during amputations are to restore a significantly disturbed general condition of the patient, in the prevention and elimination of contracture and atrophy of the stump, in the maximum strengthening and development of the muscles of a healthy limb, especially the leg, since an increased load falls on it when walking.
When a leg is amputated, the vestibular apparatus should be trained, since the patient has altered conditions for maintaining the balance of the body. When the arm is amputated, it is necessary to develop substitutional abilities.
Therapeutic gymnastics begins in 1-2 days, starting with breathing exercises, exercises to strengthen healthy limbs, especially the trunk and foot, then include exercises for the remaining joints of the injured limb (flexion, abduction, circular movements, etc.). Gradually, resistance exercises are introduced into the complex. Exercises are carried out in the initial sitting and lying positions. To prepare the stump of the lower extremity for support, massage and gradual pressure of the stump on the palm, pillow, bed, ball, sandbags, board covered with felt are performed. The stump should be hardened with cold water. From the moment of receiving the prosthesis, all attention is directed to the complete mastery of it and overcoming uncertainty. They begin with mastering walking on the floor, then on an inclined plane, stairs, stepping over, jumping, walk in high-heeled shoes, since the prostheses are designed for such shoes.
Physiotherapy exercises for stiffness and contracture of the joints
Therapeutic gymnastics is widely used for stiffness and contracture of the joints along with thermal, water procedures, and surgical interventions.
The goal of exercise therapy is to improve blood circulation, strengthen muscles, and restore normal joint mobility. Early use of exercise therapy is necessary. They begin with careful movements in the joint that do not cause pain, apply general strengthening exercises for the trunk and intact limbs. With an increase in the amplitude of passive movements, they switch to active movements, exercises with resistance. Classes during the day are repeated several times with the instructor and independently.
