1.Outline/Overview
It’s refer to the complete or partial fracture of the bone structure of upper limb and hand. The upper limbs are necessary organs for human. If the diagnosis and rehabilitation therapy are not timely, not only it will easily lead to deformity and hand dysfunction, but also limit the social and daily life self-care ability. Besides, it will affect the enthusiasm/positivity to participate in activities, wihich harm is unpredictable.The common parts of upper limb fracture, such as the supracondylar fracture of humerus, is one of the most common elbow fractures (that is the fracture in the junction of humeral shaft and condylar which is mostly caused by indirect violence. They are often caused by the external force supported by the hand when falling, the shear force generated by the forearm passing up and the body leaning forward, and the cortical fracture occurs in the special structure of the cortical bone and cancellous bone junction); Patients with forearm fractures, Fracture Radius & Ulna are more common, accounting for about 6% of the total body fractures, which are common in adolescents. Among hand fractures, the incidence of scaphoid fracture was highest , accounting for 79% of all carpal bone fracture. Thus, rehabilitation is an essential part after the fracture surgery, and how to maximize the improvement of its function is the research direction of our hand function team.
2.Clinical features
2.1 History of local trauma or fall trauma in upper limbs and hands.
2.2 Pain, swelling, skin ecchymosis or blisters in related areas.
2.3 Obvious local tenderness with bone fricative.
2.4 Severe fracture, the fractured terminal may penetrate the skin and be exposed to form an open fracture.
2.5 Notice the change of color in hands, the change of sensory and motor functions, the pulse condition, and whether the brachial artery and median nerve injury are combined.
3. Rehabilitation assessment
3.1 Definite history of trauma, history of manual reduction, external fixation or surgical internal fixation, clinical diagnosis after injury, definite X-ray film of fracture signs, postoperative and recent X-ray film.
3.2 Shoulder, elbow and hand joint dysfunction and muscle atrophy of different degrees caused by long-term immobilization,
3.3 For those combined with nerve injury, if the median nerve injury occurs, some symptoms may occur, such as thumb abduction dysfunction, muscular atrophy of the thenar eminance, paresthesia of palmaris thumb, index, middle finger abdomen and radial half of ring finger.
3.4 Assessment included: Visual Analogue Scale, Range of Motion, Manual Muscle Test, Barthel index, Function Independence Measure etc.
4. Rehabilitation goals
4.1 Pain relief.
4.2 Restore skeleton arrangement and joint stability.
4.3 Full recovery of muscle strength and range of motion.
4.4 Restore functional activities of upper limbs and hands.
4.5 Elevating the affected limb postoperatively to control swelling and to move the elbow and wrist joints as early as possible are important.
5. Postoperative rehabilitation procedures and treatment
5.1 Acute stage
The most important part of this stage is to control swelling and reduce inflammation.
1) Maintain the elbow joint at 90 degrees and neutral position of forearm;
2) arm elevation, cold compress and pressure bandaging can prevent or reduce peripheral swelling;
3) Start shoulder, wrist and hand active exercise as early as possible;
4) Pain management is also important. It allows patients to participate in the treatment process as much as possible.（Using TENS or Drugs）
5.2 Subacute stage
1) feasible joint functional exercise;
2) Improve Range of Motion;
3) Active movement technique;
4) Passive movement technique:
A accessory movement: stretch, extrusion, slip and rotation
B physiological movement
C accessory movement at the end of physiological movement
5）Stretching
5.3 Recovery stage
It should undertake rehabilitation training actively in this stage. Muscle massage and properly muscle contraction and relaxation, not only can reduce the likelihood of muscle atrophy, also prevent the adhesion of the joint, which make the function restore quickly.
6. Family rehabilitation protocol
Kinesitherapy, occupational therapy, joint mobilization, hand function training, physical factor therapy, pneumatic gloves, active involvement in the social environment and occupational therapy, is helpful for the integrity of hand function.
7. Summary/Conclusion
If the postoperative rehabilitation of upper limb and hand fractures can be timely trained and guided, and the overall recovery of upper limb and hand can be maximized, it will not cause great trouble in future activities of daily life.