TREATMENT OF FRACTURES
Newer techniques of fractures treatment are added every now and then. However, the basic principles are as follows:
1. To achieve anatomical alignment of the fractured bone ends (reduction)
2. To ensure correct immobilization (maintenance of reduction), till the fracture unites
3. To reduce inflammation and pain
4. To provide necessary compressive forces to the embryonic callus and, at the same time, discourage stretching situations to this raw callus
5. To restore maximum possible functional independence to the patient as a whole and the fractured limb in particular Fundamental stages of the management of fracture are (i) reduction, (ii) immobilization, and (iii) mobilization and rehabilitation.
Fundamental Stages of the Treatment of Fractures:
Stage I
Reduction of the fractured bones
Purpose
To secure closest apposition of fractured bony ends in the perfect anatomical alignment-at the earliest (at least within 48 h)
Methodology
• Manipulative reduction under general or local anaesthesia
• Open reduction and internal fixation (ORIF) in displaced or unstable fractures
Stage II
Immobilization of a reduced fracture
Purpose
• Ensures union of the fracture in perfect anatomical alignment
• Reduces pain
• Allows functional freedom to the fractured limb
Methodology
• POP cast
• Skin or skeletal traction
• Open reduction and internal fixation (ORIF)
• External fixation by applying external fixator
Stage III
Mobilization and Rehabilitation of the fractured joint and the limb
Purpose
• To restore maximum possible functional self-sufficiency to the patient by various physiotherapeutic measures
Methodology
• Restoring normal ROM to the joint affected following immobilization
• Achieve minimal possible required functional ROM when a fracture involves a joint
• Restore to the maximum all the functions of the muscles affected by fracture and immobilization
• Training to use assistive aids for functional self-sufficiency
• Use of specialized exercise techniques
Reduction of Fracture:
The aim of reduction is to achieve perfect anatomical alignment and length of bone. Reduction of a fracture could be (i) closed, where the alignment of fractured bony ends is achieved by manipulation, and (ii) open, where alignment is achieved by surgery.
Immobilization of Fracture:
Maintaining or holding the fracture reduction is important and can be achieved by immobilization. The methods of immobilization are as follows:
1. Traction
2. Plaster of Paris cast (POP Cast)
3.Functional cast bracing
4. Internal fixation
5. External fixation
Mobilization and Rehabilitation:
It is the final stage of fracture treatment. The objective is to restore near-normal mobility to the fractured limb and make the patient physically independent. It is in fact the total responsibility of the physiotherapist.
