The tibia is the main bone connecting the lower femur to support the weight, and the fibula is an important bone attached to the calf muscle, bearing the load of 1/6. Because of their position, tibia and fibula are more likely to be crushed by direct violent impact, and because tibia is close to the skin before and after, it is mostly open fracture. Severe trauma, large trauma area, high degree of fracture fragmentation, serious pollution and tissue contusion and laceration are the characteristics of tibia and fibula fractures, and which treatment method is the best has always been one of the most controversial issues in fracture treatment.
Tibiofibular fracture is a special type of lower limb fracture. Long treatment time and many complications. Because the function recovery is slow, it is prone to dysfunction. In normal clinical treatment, only 17.6% of patients fully recovered, especially in remote areas, and the data is even lower.
Regarding the postoperative rehabilitation exercise of tibiofibular fracture (the following is the personal exercise schedule shared by patients), we will explain it one by one according to time:
(1) toe joint movement began on the third day after operation. The slight movement of each toe will cause some numbness and numbness. 3-4 times a day, 50 times each time.
(2) On the 5th day after operation, ankle joint activity began. Pull the instep back hard to lay the foundation for future squat exercises. The angle of reference healthy feet is generally 80-90 degrees. 3-4 times a day, each time 100 times, with force.
(3) On the 7th day after operation, the knee began to move. This is an arduous exercise, which is very necessary. You can't be lazy. It takes a long time, and sometimes it's a little hard to practice. At first, I will touch my knee, and when I bend it, I will hear the tendons click straight and not smooth. Kneeling, from 180 to 90 degrees is the first stage, from 90 to 45 degrees is the second stage, from 180 to 45 degrees is the third stage, and from 45 degrees to 15 degrees is the fourth stage. The first stage, 4-6 times a day, each time in 10, normal 10 days can enter the second stage.
(4) Day 10 after operation: Start leg lifting exercise. It is very important to practice the strength recovery of thighs and calves, especially the strength recovery of thighs, to avoid atrophy of thigh muscles.
(5) Day 12 after operation: Start combined exercises-leg lifting, knee bending (first stage), instep bending and toe movement. At least 4-6 times a day, 20-50 times each time. Bend your knees to resist the pain of acid swelling and hard pressing, and bend your instep to resist the obstacles of acid swelling and numbness. However, we should also pay attention to it, which can only be accepted by ourselves and cannot be forced.
(6) Day 20 after operation: Kneeling posture (second stage) practice. At this stage, you sometimes suffer from the external force exerted by the doctor, because 90 degrees is a difficult hurdle for some people to break through, and the toe-ankle and thigh combination exercise continues.
(7) The 28th day after operation: kneeling posture (the third stage). This is actually a consolidation and improvement of the previous exercises.
(8) 30th day after operation: healthy legs exercise on the ground. This is early and late, which varies from person to person. However, you have to get used to it for two days before you can get on the ground. Because you stay in bed for a long time, your healthy legs will suddenly feel weak and your knees will bend when you get down to the ground. Pay special attention not to hurt your leg.
(9) Day 32 after operation: Blood circulation training of injured leg. That is, people are still in bed, but let the injured legs start to stand upright, not touching the ground, and can't bear the force. The injured leg will obviously change color, first red, then black, then purple, and the foot will begin to swell and feel bloated. Turn your feet upside down or lay them flat, and you will recover soon.
Day 35 after operation (10): landing on one foot+crutches. This is also a solid exercise, a solid exercise in healthy leg strength training, and a solid exercise in blood circulation of injured legs. At the same time, I began to practice operating crutches.
(1 1) The 45th day after operation: The injured leg (footboard) tried to touch the ground, but failed to bear the force. The soles of your feet will feel slightly swollen.
(12) 49th day after operation: practice sitting. Put the leg flat, and the injured leg will naturally be placed from the stress point. During the injury, the legs will be swollen, discolored, the calves will become hard and the thighs will become sour. This is normal, there is a process.
On the 53rd day after operation (13), I practiced landing with crutches, but my injured leg could not bear the force. In fact, it is to practice walking posture. It's best not to use force when you hurt your leg, just make a gesture next to the ground.
The 56th day after operation (14): Practice the strength of injured leg. If you have the conditions at home, you can buy a weighing scale, step on it bit by bit with your injured leg, and increase the target by 2-3kg every day. Be careful not to rush for success, and stop immediately if you feel unwell.
(15) 60 days after operation: practice "walking with crutches and injured legs". When the injured leg can bear the weight of 1/3, it has the theoretical condition of "walking with crutches" But for the sake of safety, it is safer to practice when the injured leg weighs 1/2.
(16) Day 63 after operation: rock climbing practice. Look for slopes above 30 degrees and practice going up and down. It is mainly to train the bending degree of ankle joint, laying the foundation for the next step of going up and down stairs, and also laying the foundation for the bending of squatting ankle.
(17) On the 67th day after operation, we practiced "walking on one leg". When the injured leg can bear the weight of 1/2, theoretically it has the condition of "walking on one leg". But to be on the safe side, it's safer to practice when the injured leg weighs 2/3.
70th day after operation (18): The injured leg should be able to bear all the weight. (19) 765438+ 0 days after operation. Practice going up and down stairs. Help, not on crutches. Among them, going downstairs is difficult and dangerous. There is a process to increase the strength of strength and foot injury, which requires more time to practice.
(20) The 77th day after operation: Squat exercise. There will be some discomfort, but don't rush it.
(2 1) 80th day after operation: walking on the abduction ground. It is best to practice slowly from holding and holding the wall.
(22) 84th day after operation: Take off crutches and go up and down stairs. It is best to practice slowly from crutches, railings and walls.
(23) 90th day after operation: Walking distance exercise. Consolidate the results of abduction exercises and practice the endurance of bearing the injured leg. Correct your walking posture.
(23) 100 days after operation: self-inspection training results. See what is not up to standard and remedy it as soon as possible. Reaching the standard means that the injured leg and the healthy leg are on the same level. In addition to the injured leg without rotation, other functions can be restored to the level of healthy leg.
For tibiofibular fractures, we should adhere to the principle of early exercise and later weight bearing.
Healing period: supine position should be taken, and the affected lower limb should be slightly raised with a soft pillow to facilitate venous return.
After orthopedic treatment, health gymnastics, upper limb muscle strength exercise, active exercise of affected limbs, ankles and toes, and isometric contraction of quadriceps femoris of affected limbs began 3-4 days after lying flat.
/kloc-about 0/5 days, increase the active flexion and extension of hips, knees and ankles, isometric contraction of toes and anti-hip exercises.
Patients with external fixation for about 45 days can walk at three points with double axillary crutches, and the affected limb does not touch the ground.
It can be buckled along the longitudinal axis at the sole of the foot twice a day, 200 times each time.
Recovery period: After the external fixation is released, increase the active exercises of knees and ankles, stand on the inclined bed, and start the supported sitting exercise after 15 days, and do the exercises of standing on tiptoe, squat and feet.
Do hip flexion, extension, adduction, abduction and knee and ankle flexion and extension resistance exercises.
After 30 days, the practice of standing on crutches was changed to walking alternately with both lower limbs to increase the resistance exercise of ankle varus, and then walking at four o'clock to gradually increase the load of the affected limb.
Precautions reminder:
1, during exercise, you should pay attention to prevent excessive exercise or strenuous activity, and stop immediately if you are intolerant.
2, exercise correctly under the guidance of a doctor, not blindly, not impatient.
3, quit smoking and drinking, smoking is not conducive to wound healing, easy to increase the probability of nonunion (in the outpatient department of nonunion patients, patients who are still smoking do occupy a part, and have time to focus on this issue), for drinking, drinking is strictly prohibited during the healing period, and drinking is not recommended during the recovery period.
4. A reasonable and balanced diet. The most discussed here is bone soup, which does little help to fracture healing, but does more harm than good. Eat less spicy and stimulating food (for the problem of diet, you can read the content about diet published before Talking about Bone and Producing Body Fluid for a detailed understanding).
5. Take a reasonable rest and keep a good mood.
6. Get more sunshine.
7, avoid sexual intercourse (in this piece, I have had a lot of exchanges with friends of western medicine, but the rhetoric of this piece is very vague, some say it is ineffective, and some say it is not recommended, because I am worried that strenuous exercise will cause secondary injuries [face]. As a Chinese medicine practitioner, my advice is always to advise patients.
8, pay attention to prevent deep vein thrombosis of fractured limbs. After fracture, due to local injury, slow blood flow and some coagulation factors, deep venous thrombosis will form in the fractured limb. Once a thrombus is formed, it is still very troublesome to treat. Especially the lower limbs are easier to form.
In view of the postoperative rehabilitation exercise of tibia and fibula fracture, we should do early exercise, late load bearing, step by step, and follow the doctor's advice in order to recover as soon as possible. If you have any questions, please leave me a message.
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