After a fracture of the arm bones and a long stay in a cast in an immobilized state, muscle atrophy and a decrease in the range of motion in the joints are observed. Decreased mobility has a negative effect on recovery results. The patient loses his ability to work, despite the fact that the bone has fused. During the recovery period, there comes a time for active development of the limb, aimed at increasing the volume of active movements. The article discusses how to develop a hand after a fracture and what methods are used for this.
Anatomy of the forearm.
The forearm consists of two bones - the ulna and the radius.
If you stretch your arms forward with your palms up, the ulna will be on the little finger side, and the radius will be on the thumb side. The ulna widens at the elbow, and the radius widens towards the wrist. The main movement performed by the forearm is rotation. In this case, the ulna is rigidly fixed in a block with the humerus, and the radius rotates around it. This movement occurs, for example, when screwing in a light bulb or opening a door with a key.
In some cases, significant displacement of the fragments occurs, as a result of which they perforate the skin. This type of fracture is called open, and it requires immediate surgical intervention, as it is characterized by a high risk of infectious complications.
General exercises
In the second period, classes are conducted while sitting at a table. The gymnastic complex consists of five main types of exercises:
- you need to place your hand and shoulder joint on a hard surface;
- you need to perform the exercise with the help of additional equipment, it involves two hands;
- it is necessary to place the affected limb on a hard surface in a bent position, with the elbow bent at 30 degrees;
- place the limb on the table so that the hand hangs down;
- The lower limb should rest on the healthy forearm.
This gymnastic complex is performed for two months and, as recovery occurs, the load and intensity of the exercises increases.
Symptoms of a forearm fracture in the middle third.
Symptoms of a forearm fracture in the middle third are standard for any fracture - pain, swelling, bruising, bone crepitus, deformity, impaired hand function.
With open injuries, a violation of the integrity of the skin also occurs. With very severe soft tissue damage, the fracture can be complicated by the occurrence of compartment syndrome, in which high interstitial pressure leads to irreversible damage to muscle tissue. In any case, if you have the above symptoms, you should immediately consult a traumatologist.
Introduction
The formation of this disease can be caused by exposure to direct and indirect force. For example, an injury can be either caused by a blow from outside or received by falling on a given organ. Hence, the types of fractures are distinguished - transverse, oblique, comminuted.
The duration and method of treatment with the recovery process directly depend on the nature of the injury. The approximate treatment time is 5 to 10 weeks.
For any type of fracture, the patient is prescribed complex therapy, which includes physical therapy, since health-improving gymnastics has a positive effect on the restoration and fusion of the limbs. It improves blood supply and, as a result, bone tissue receives the necessary nutrients. Exercise therapy for the forearm allows you to restore damaged bones, restore mobility and tone to weakened muscle tissue.
Treatment of fractures of the middle third of the forearm.
Fractures of both forearm bones in the middle third in adults should almost always be treated surgically. In a cast it is impossible to adequately compare bone fragments in a fracture of the forearm in the middle third, and even if it is possible, secondary displacement always occurs. This subsequently leads to dysfunction of the limb. Plaster immobilization is almost always used as a temporary measure to prevent secondary displacement, perforation of the skin with bone fragments, damage to the neurovascular bundles, and reduce pain. Surgical treatment is currently most often represented by open reduction and osteosynthesis with plates. In some cases, closed osteosynthesis with locking pins, wires, or flexible rods can be used, and in open fractures, it is preferable to apply an external fixation device. In children, this group of fractures can be treated conservatively if adequate reduction can be achieved in a plaster cast.
Below is a clinical example of the treatment of a patient with a forearm fracture.
Patient X. Trauma at home, fell on a curb, received a closed fracture of both bones of the right forearm with displacement, rupture of the distal radio-ulnar joint. I contacted the RTP and x-rays were taken. A plaster cast was applied.
The patient contacted K+31; given the nature of the fracture, the patient was offered surgical intervention.
Intraoperative assessment of the stability of the distal radioulnar joint.
Osteosynthesis of both bones of the right forearm was performed with 3.5 mm metaphyseal plates, and the distal radioulnar joint was fixed with a screw.
Appearance of the limb after surgery, angular deformity eliminated. The limb segment is stable, movements in the elbow and wrist joints are not limited, rotation of the forearm is limited due to the presence of a positioning screw, which will be removed after 6 weeks.
X-rays after surgery.
This osteosynthesis is very stable and allows you to begin rehabilitation within a day after surgery. Forced loads on the forearm are naturally limited until x-ray confirmation of consolidation. It is advisable to perform X-ray control after 6 and 12 weeks. If signs of fusion are well expressed, full weight bearing is possible 12 weeks after surgery.
First stage of treatment
Therapeutic gymnastics is performed the next day after the injury, but in some cases, exercises begin after the pain has subsided. A set of exercises is done daily 8-10 times a day.
The patient must perform all types of exercises on the fingers and on the shoulder joint itself. However, doctors strictly prohibit performing those types of exercises that cause pain, as this can negatively affect the fusion of the limbs. As basic exercises you can use:
- flexion and extension of all limbs up to the palm;
- bend each finger separately.
Possible complications after osteosynthesis of the middle third of the forearm.
Infection. There are certain risks of infectious complications with any surgical intervention, forearm osteosynthesis is no exception.
Damage to nerves and blood vessels. There is a small risk of damage to the nerves and blood vessels at the level of the forearm during surgery. If after surgery there is weakness and numbness in the hand area, or persistent limitation of movements appears, this is a reason to consult a doctor, since such neuropathy may not resolve without emergency intervention.
Synostosis. In some cases, after a fracture of both bones of the forearm, a bone bridge may arise between them, which will limit the rotational movements of the forearm.
Nonunion. The operation does not guarantee healing of the fracture. Sometimes the bone does not heal, and in such cases a repeat, more complex operation is required.
Smoking and drinking alcohol slow down the healing process and may lead to delayed fracture consolidation.
Fracture concept
When a hand is broken, it means a violation of the integrity of the bones that make it up.
These include:
- brachial bone;
- ulna;
- radial;
- bones of the hand, fingers.
This group includes intra-articular fractures (shoulder, elbow, wrist, phalangeal joints). After a fracture, their mobility is often impaired due to developed contractures in the joints, a decrease in the range of passive and active movements. Muscle tone is impaired and the elasticity of ligaments is reduced.
IMPORTANT If you do not develop the arm after a bone fracture, as a result of a long stay in a cast, the patient will not regain his ability to work. And in the absence of competent rehabilitation, the patient experiences severe disability.
Rehabilitation after osteosynthesis surgery of the middle third of the forearm.
After osteosynthesis surgery, it will take a short period of time for swelling and pain to subside before you begin active rehabilitation. In the early postoperative period, it is possible to use a scarf bandage to reduce pain and for disciplinary purposes. Topical use of ice or cryotherapy gel bags, which are sold at any pharmacy, can effectively combat pain and swelling. Their use is also possible at a later date from the operation.
For the first 2-3 weeks, physical therapy is limited to performing movements in adjacent joints - the elbow and wrist; starting from the 3rd week, a gradual onset of rotational movements is possible. Full amplitude is restored by 6 weeks after the intervention. Physical activity is not allowed before there is a clear x-ray picture of fusion, which usually occurs by 3 months. The decision to remove metal fixators is made no earlier than 2 years from the date of surgery.
Warm-up
The patient should not forget that any exercise begins with warm-up exercises. This is necessary in order to warm up the muscle tissue, normalize tone and prepare it for more complex exercises. As a warm-up, you can rub all the phalanges of your fingers, and also use a special massage ball. They can be used to walk over the entire surface of the sore arm. In addition, at the pharmacy you can purchase a special ring for exercise therapy.
Attention! Physical education is aimed at minimizing discomfort from shoulder and forearm injuries and ensuring accelerated remission.
Rehabilitation periods
The main goal of rehabilitation is to restore the full range of movements. The rehabilitation process is divided into specific periods and requires an integrated approach. In this case, it is necessary for the patient to follow all the recommendations of the attending physician.
There are three periods of rehabilitation when recovering from a broken arm:
- Immobilization – at this time the patient is in a cast. In terms of time, this rehabilitation period lasts for various fractures up to three months. At this time, movements are performed in joints that have not been immobilized.
- Functional - this stage lasts up to six months after the removal of the cast, during which active development of the muscles and joints of the upper limb is carried out. First, basic movements and limb functions are trained. Then, through exercises, the patient is restored to the ability to perform complex coordinated actions and the range of movements in the joints is expanded.
- Training – continue to develop motor range in the joints and active movements. Restore the patient's ability to work. Use weighted exercises. Exercise therapy continues for up to a year after the fracture.
High-quality, timely rehabilitation and exercise therapy helps the patient to restore their ability to work and maintain their quality of life.
Development at the immobilization stage
They begin to develop the arm on the second day after repositioning the bone fragments. Exercises are performed in a gentle manner in areas free of plaster. And they are carried out only in the absence of contraindications, if they do not increase pain and swelling. The simplest exercises can improve blood circulation in muscles and bones. They prevent the development of muscle atrophy and joint contracture.
How to develop a limb in a cast
Exercise therapy exercises are carried out on areas of the upper limbs that are not limited by plaster.
Exercise therapy exercises are used for rehabilitation:
- A useful exercise is the use of a wrist exerciser in the form of balls with a diameter of five centimeters.
- The fingers of the broken hand are clenched forcefully into a fist, unclenched again and spread as far apart as possible. Repeat the exercise twenty times a day.
- Kneading the bone using a special expander. The intensity, speed and strength of the exercise are increased gradually.
- Connecting the pads of each finger with the thumb into a ring in turn.
Terms of rehabilitation
How long does rehabilitation take for a broken arm? This process, depending on the severity of the damage, takes up to a year.
The recovery speed depends on the following parameters:
- patient's age;
- severity of the fracture;
- concomitant pathologies;
- type of damage;
- patient discipline when performing exercise therapy;
- presence of previous injuries in this place.
Failure to follow the doctor’s recommendations increases the recovery time for the injured limb.
