Postoperative limb functional position of fracture patients

- May 22, 2020-

Postoperative limb functional position of fracture patients


Excision of superior or lower patella, reattachment of quadriceps tendon

(1) Removal of small bone fragments or crushed parts of fractures, attach the patellar ligament to the upper segment of the patella, or attach the quadriceps muscle to the lower patellar fracture

(2) Post-operative treatment with a large amount of dressing, long legs cast in a straight position fixed for 3 weeks, after removing the cast to practice joint activities without weight-bearing. After 6 weeks, abduction gradually walked with weight, and strengthened joint mobility and quadriceps muscle strength exercise. This method can preserve the patella effect, heal quickly, the function of the four heads of the femur can be restored, and there is no problem of fracture healing and unsmooth joint surface.

 

Total patella resection

It is suitable for severe comminuted fractures that cannot be reduced or partially resected. When removing the crushed fracture, the periosteal and quadriceps aponeurosis should be protected as much as possible. After resection, the torn expansion and joint capsule are sutured to restore normal tightness. Then, pull down the quadriceps tendon and suture the patellar tendon.

If the suture cannot be directly sutured, the quadriceps tendon can be reversed to repair the suture. Make a "V" -shaped incision in the quadriceps tendon, turn down the cut tendon flap, and repair the newly formed defect after the patella is removed. The lateral femoral and quadriceps tendon flaps can also be used to reverse the repair of the patella defect. After the operation, the cast was fixed for 4 weeks and the knee extension and flexion activities were practiced.

 

Total hip replacement position

It is the abducted middle position of the affected lower limb when lying down. After operation, the hip joint usually needs skin traction of the lower extremity, placed in the abduction and rotation position, and fixed with a hard triangular pillow between the two lower extremities to avoid extreme flexion, adduction and adduction of the hip joint during the recovery process. Rotation, causing dislocation of the hip joint.

The triangular pillow can be fixed for 5 to 14 days, and its use is particularly beneficial to non-surgical side lying positions. Place a cotton pad under the knee and calf of the affected limb to avoid unnecessary compression of the skin and nerve trunk. During the rollover activity, one person gently stretched the affected limb to maintain abduction neutrality, and extended the roll to the healthy side, and then placed a pillow on both legs to maintain the neutral position of the affected limb, avoid adduction of the hip joint.

Special care should be taken when handling the patient. The pelvis should be lifted up completely, avoiding hip flexion to prevent dislocation. If the patient has severe hip pain, and the limb becomes internal or external rotation, it should be reported to the doctor immediately to further determine whether there is a possibility of dislocation.

 

Tibia and fibula fracture

Healing period:

(1) In supine position, the lower limb of the affected side should be slightly cushioned with a soft pillow to facilitate venous return.

(2) 3 to 4 days after orthopedic treatment, health gymnastics, exercise of upper limb muscle strength, active exercise of hip, ankle, and toe of the affected limb, and isometric contraction of the quadriceps muscle of the affected limb are started in the lying position.

(3) Increase hip, knee and ankle joint active flexion, extension and toe isometric contraction and hip resistance exercises in about 15 days.

(4) Patients with external fixation around 45 days can hold two axillary crutches for a three-point walk without touching the affected limb.

(5) Strike along the longitudinal axis on the sole of the foot, twice a day, 200 times each time.

Recovery period:

(1) After removing the external fixation, increase the active exercises of the knee and ankle joints, stand on the slant bed, and start doing sit-up exercises with support and do tiptoe, squat, and practice with both feet standing after 15 days.

(2) Do resistance exercises for hip flexion, extension, adduction, abduction and knee-ankle joint flexion and extension.

(3) After 30 days, the practice of standing on the pole will be changed to alternate walking of both lower limbs, increasing the resistance exercise of ankle valgus, and then supporting the axillary crutches to do four-point walking, gradually increasing the weight of the affected limb.

 

Cervical traction

Posture: You can take a sitting or lying position. For convenience, take a more stable sitting position, so that the neck is forward forward from the longitudinal axis of the trunk by about 10 ° to 30 ° to avoid overextension. Ask the patient to fully relax the neck, shoulders and entire body muscles. The traction posture should make the patient feel comfortable, and adjust if necessary. The anteversion angle of patients with vertebral artery type should be small, and patients with cervical spondylotic myelopathy should take a nearly vertical posture, avoiding flexion and traction.

Traction weight and duration: Commonly used traction weights vary greatly, from 1/10 to 1/5 of the patient's own body weight, most of which are 6-7 kg. At the beginning, a smaller weight is used to facilitate the patient's adaptation. At the end of each traction, the patient should have an obvious neck stretch feeling, but no special discomfort. If this feeling is not obvious, the weight should be increased as appropriate. The duration of each traction is usually 20 to 30 minutes. The traction weight and duration can be combined differently. Generally, the duration is shorter when the traction weight is larger, and the duration is longer when the traction weight is smaller.