Rehabilitation in fractures

Immobilization as the first stage of recovery

The success of subsequent limb mobilization directly depends on the correct position of fragments and joints during the fixation period. In conservative treatment of forearm bone fractures, plaster casts are used, the boundaries and shape of which depend on the level of injury:

• In an isolated radius fracture without displacement, the cast is applied from the upper third of the arm to the fingers. The forearm is flexed at a 90° angle. If the upper third is fractured, the arm is fixed in a neutral position; if the lower third is fractured, in pronation. The immobilization period is 8–10 weeks.
• In fractures of the radius in a typical location (without displacement), a deep dorsal slab is used from the base of the fingers to the upper third of the forearm. The hand is brought into slight dorsal flexion, and the forearm is left in the mid-position between supination and pronation. Fixation lasts for 4 weeks.
• In a flexion Monteggia fracture, a slab is applied from the metacarpophalangeal joints to the axillary fossa. Initially, the arm is extended and the forearm is supinated. The total duration of wearing the cast reaches 10–12 weeks.

Already during the immobilization period, the patient is prescribed courses of physical therapy and physiotherapy.

Prevention of contractures and muscle atrophy

Prolonged immobility leads to joint stiffness and weakening of the muscular framework. To minimize these consequences, active rehabilitation measures start in the first days after the injury:

1. Early active movements. For any forearm fractures, movements of the fingers are permitted and encouraged from the first days (usually from 2–3 days). If the shoulder joint is free from the cast, a full range of motion must also be performed in it.
2. Maintaining muscle tone. Throughout the entire immobilization period, the patient must perform rhythmic muscle contractions under the cast. This improves blood circulation and prevents pronounced atrophy.
3. Gradual position change. A specific approach is used in the treatment of flexion Monteggia fracture. 4 weeks after repositioning, the forearm is moved to a flexed position (up to 90°). This manipulation is critically important for the prevention of elbow extension contracture.
4. Transition to joint mobilization. By the end of the second month, the rigid circular cast is replaced with a removable one. This allows for cautious, dosed mobilization of adjacent joints—the wrist and elbow—preparing the arm for complete removal of fixation.

Timeframes for return to work

The time required for a patient to return to normal life and work varies depending on the severity of the injury and the involvement of adjacent structures:

• The fastest recovery is observed in fractures of the radius in a typical location without displacement—ability to work returns after 5–6 weeks.
• Isolated diaphyseal injuries of the radius require longer healing. The patient can return to work after 10–12 weeks.
• Combined injuries, such as a Monteggia fracture (ulnar fracture with radial head dislocation), have the longest rehabilitation period. Full recovery of function and work capacity takes from 12 to 16 weeks.

Rehabilitation after limb-sparing surgery

Special attention is required during the recovery period in musculoskeletal oncology. For localized bone tumors without metastases, the priority is the removal of the neoplasm with maximum preservation of the affected limb (Limb-sparing surgery).

After tumor resection and bone reconstruction (using bone grafts or hinged endoprostheses), the patient undergoes prolonged physiotherapy. The main goals of this stage:

• Restoration of muscle strength.
• Return of adequate joint range of motion.
• Maximum restoration of the supportive and motor function of the limb.

Despite the complexity of the surgical intervention, the recovery period after a well-performed limb-sparing surgery proceeds faster than after amputation. At the same time, preserving one's own limb provides the patient with a significantly higher quality of life, and disease-free survival rates remain identical to radical amputations.

Class and exam questions

What else to study on this topic

• Injury mechanisms and classification of forearm bone fractures
• Radiological criteria for displacement: Colles and Smith angles
• Closed manual reduction technique in Monteggia fractures
• Indications for prophylactic internal osteosynthesis in bone metastases
• Specific complications of radiation therapy: osteonecrosis and pathological fractures

Other topics in the "Specialized Adult Traumatology" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.