Rehabilitation after a broken leg

Injuries with fractures of the leg bones are the second most common. They require long-term treatment and rehabilitation. If all activities have been carried out correctly, then it is usually possible to achieve a good prognosis in terms of functional recovery. How to develop a leg after a fracture, the attending physician determines on an individual basis.

Types of fractures

Fractures of the bones of the lower limb occur as a result of a fall, direct mechanical impact in the form of a blow or rotation on the leg along the axis with a fixed foot. Depending on the location of the damage, fractures of the femur, tibia, fibula, and structures of the foot are distinguished. According to the concomitant damage to the skin, open (there is damage to the soft tissues and skin by bone fragments) or closed fractures are distinguished. According to severity and prevalence, there are:

• Complete fracture - there is a violation of the integrity of the bone along the entire width, which can lead to displacement of the fragment.
• Incomplete - after damage, the general anatomical structure and shape of the bone do not change (fracture).

A fracture can develop as a result of trauma or have a pathological origin, when the strength of bone tissue decreases and damage develops against the background of exposure to normal loads. If the violation of integrity has affected several bones, then a combined fracture occurs.

Classification of injuries is necessary to select the optimal tactics of treatment and rehabilitation. Usually, after injuries with displacement or against the background of combined fractures, operative reposition (comparison of fragments) is required, followed by osteosynthesis (fixation of fragments with pins, the Ilizarov apparatus, pins), immobilization and long-term recovery.

Stages of rehabilitation

Rehabilitation after a leg fracture is a complex event that has a different duration and includes several stages:

• Activities during immobilization (immobilization) of the limb.
• Functional restoration of the leg.
• Training stage with the expansion of motor activity and loads.

There is continuity for stages. Each subsequent one begins after the completion of all the activities of the previous one after a certain period of time. The attending physician periodically monitors the effectiveness of rehabilitation measures.

Immobilization stage

Immobilization of the limb, which can last for months, leads to a slowdown in blood flow in the tissues. This causes a violation of the course of regeneration processes, increases the risk of the formation of contractures (connective tissue "unions") in the joints with subsequent limitation of movements in them. With the help of simple measures, it is possible to achieve improved blood circulation in tissues, reduce the severity of edema, which is especially important under a plaster cast, increase muscle tone and normalize metabolic processes in cartilage. Rehabilitation is contraindicated in the presence of the following pathological conditions:

• the presence of open injuries of soft tissues, including after the installation of the Ilizarov apparatus;
• fever (increase in body temperature above +38 ° C), as a result of which infectious complications cannot be excluded;
• the appearance of rashes on the skin;
• acute infectious or somatic diseases, exacerbation of chronic pathological processes;
• pathology of the blood system.

In these cases, the activities are selected by the attending physician individually together with other specialists.

If there are no contraindications, then the treatment of the leg after a fracture and the first stage of rehabilitation include the following measures:

• Diet - the diet includes foods rich in easily digestible proteins, vitamins and mineral salts, which contributes to rapid tissue regeneration. To reduce the load on the digestive system, as well as better absorption of food, it is recommended to take small portions at least 5 times a day. Dinner should be no later than 2 hours before the intended sleep.
• Massage - stroking, rubbing, kneading the tissues above and below the plaster cast. The procedure increases the intensity of blood flow in the tissues, which stimulates regeneration processes.
• Rubbing the skin of the leg with cedar oil, decoctions of medicinal plants.
• The use of drugs of various pharmacological groups - as necessary, the attending physician prescribes non-steroidal anti-inflammatory, decongestant drugs, multivitamins, chondroprotectors, mineral salt preparations.
• Physiotherapy procedures.

Physiotherapy has become widespread during the implementation of rehabilitation activities. It involves the impact of certain physical factors:

• Magnetotherapy - regeneration processes in tissues improve due to stimulation of nerve endings by a magnetic field.
• Electrophoresis is a technique of local exposure to an electric current of a certain strength and frequency, which improves the penetration of drugs through the skin to the focus of the inflammatory reaction.
• Applications with wax and ozocerite - applying heated paraffin to the skin helps to increase the intensity of blood flow in the tissues.
• Laser therapy - laser exposure stimulates metabolic processes and increases the rate of tissue regeneration.

The choice of the method of physiotherapy is influenced by the type, localization, severity of the fracture and the technical capabilities of the medical institution. The stage lasts from several months to six months, depending on the severity of the injury. The time, frequency and duration of physiotherapy, massage, medication is determined by the attending physician individually.

Recovery

At the second stage of rehabilitation, physical therapy (exercise therapy) is added to general recommendations, a rational diet, and physiotherapeutic procedures. It is prescribed after the removal of a plaster cast or other devices for immobilizing the lower limb and has several goals:

• improving tissue nutrition by stimulating blood circulation in them;
• restoration of lost leg functions (range of motion in the joints, strength and tone of skeletal muscles);
• prevention of the formation of connective tissue "adhesions" in the joints with subsequent violation of movements in them.

To achieve the main therapeutic goals, special exercises of physiotherapy exercises are used:

• foot rotation;
• walking with a gradual increase in the load on the injured leg;
• alternate lifting of legs straightened at the knees in a sitting position on a chair;
• shifting body weight from socks to heels (during the exercise, you need to hold on to a chair);
• performing swings with legs straightened at the knees, to the sides in a supine position.

After a severe injury with a long recovery period, passive movements in the joints of the legs are first prescribed, which are performed by a doctor or a rehabilitation specialist. Then, as the functional state is restored, active exercises are started. The second recovery phase lasts a few months on average. It can be done at home.

Training stage

The development of the leg after a fracture during the third stage is aimed at adapting all structures of the lower limb to a gradual increase in functional load. To do this, the main emphasis is on the implementation of various exercises of physiotherapy exercises:

• walking for at least half an hour a day (preferably in the fresh air);
• performing exercises on an exercise bike with a gradual increase in load;
• exercises aimed at flexion and extension of the legs in the knee joint (it is advisable to use simulators);
• squats;
• swimming.

In the future, exercises after a broken leg include running, athletics. They are usually prescribed for the rehabilitation of people who play professional sports. The training phase lasts from several months to six months.

The rules of physical therapy

To obtain the desired effect from exercise therapy, to prevent complications and negative consequences, several rules should be followed:

• no “amateur activity”, all exercises are prescribed by the attending physician or rehabilitator;
• exercises must be performed in strict accordance with the recommendations, including the duration, frequency of approaches;
• the load on the lower limbs must be dosed;
• functional load on the legs increases gradually;
• with the appearance of pain in the leg of varying severity, signs of an inflammatory reaction (redness, swelling of tissues), the development of bleeding, exercise should be stopped and consult a doctor for qualified help;
• continuity of stages, physiotherapy exercises begin with simple exercises, which become more complex as functional recovery progresses;
• simultaneously with physiotherapy exercises, other rehabilitation measures are necessarily carried out (diet, general regimen, drug treatment, physiotherapy procedures);
• the duration of physiotherapy exercises is determined only by the doctor, who also controls the effectiveness of the measures taken.

Regardless of what the leg fracture was, rehabilitation with exercise therapy must be carried out taking into account the rules and recommendations.

Features of rehabilitation depending on the injury

Therapeutic tactics is determined by the doctor after the diagnosis, which includes instrumental bone imaging techniques (X-ray, computed tomography). In case of uncomplicated fractures of small bones (ankle, tibia, fibula), after closed reposition, they are limited to applying a plaster cast. The duration of rehabilitation does not exceed several months.

If both bones (tibia and fibula) of the lower leg are damaged, then the Ilizarov apparatus is used for reposition and subsequent immobilization. In this case, the approaches to the implementation of rehabilitation measures change. Preference is given to drug therapy, skin care with the prevention of infectious complications and the subsequent performance of passive movements in the joints. After removing the apparatus, active exercises are included in the complex of physiotherapy exercises.

A hip fracture is a serious injury. The injury is accompanied by spasm of the thigh muscles. When bone fragments are displaced, reposition requires skeletal traction, which lasts up to six months. After immobilization, physical therapy is necessary, which begins with passive movements in the joints. As the functional recovery of the leg, classes with active exercises begin, which last for several months. Physical therapy necessarily includes walking with a gradual increase in the load on the injured leg.

Rehabilitation after a leg fracture at home can be carried out already at the first stage, if immobilization was carried out using a plaster cast. In other cases (skeletal sprain, Ilizarov apparatus), all activities are carried out in a medical hospital. At home, the patient must disciplinedly fulfill all medical prescriptions and recommendations. In case of any changes, he should seek qualified help. Monitoring the effectiveness of the rehabilitation carried out by the attending physician at the reception. If necessary, he additionally appoints an instrumental objective examination.

How to develop a leg after a fracture, how to achieve functional recovery and avoid complications is determined by the attending physician. After an injury and first aid, the injury is diagnosed, the nature, localization and severity of injuries, which makes it possible to choose treatment tactics and rational rehabilitation.