Physical therapy after any fracture can be difficult and painful. However, the complications associated with a displaced bone fracture pose unique challenges during your rehabilitation and recovery. Following the recommendations of your orthopedic doctor and physical therapist will provide you with the best opportunity for a speedy recovery and improved long-term outcome.
Associated Surgical Interventions
Some common displaced bone fractures occur at the hip, the shin and in the wrist and forearm. Your orthopedic surgeon will determine the best intervention following your injury. For the least invasive, least severe injury, your surgeon may complete a closed reduction procedure, manually repositioning the bone prior to casting. For more severe fractures, most surgeons will opt for open reduction, internal fixation, or ORIF, wherein your surgeon will place a pin, a plate or a combination of both onto your bones to ensure proper alignment. Occasionally, your orthopedic surgeon will supply an external fixator, which are pins that are visible outside of your skin and are often sequentially adjusted to encourage the bones to realign. For the worst fractures at a joint, your surgeon may need to replace the joint entirely if the displacement is extreme.
Weight-Bearing Limitations
Your weight-bearing of the affected limb will be limited following your injury. The least severe displaced fractures often require six weeks of non-weight-bearing. The most significant injuries can result in doctor-mandated, non-weight-bearing for up to six months. Any infection and subsequent revision of the surgery results in an extension of your non-weight-bearing. Every two to four weeks, you will visit your surgeon and receive x rays to determine the level of healing of your fracture. Your orthopedic doctor will use this information to determine if you can advance your weight-bearing to toe-touch weight-bearing, partial weight-bearing or weight-bearing as tolerated. Your therapist will teach you how to comply with these limitations.
Exercise
During your period of weight-bearing limitations, your physical therapist will strengthen your healthy limbs. For lower extremity displaced fractures, you will often be unable to complete even range of motion (ROM) on the fractured limb. However, your physical therapist (PT) will use weights and exercise bands to strengthen your opposite leg. Because you will need to use significant upper body strength to walk with crutches or a walker, your PT will also strengthen your arms. If your upper arm, shoulder or elbow is broken, your doctor will often allow your PT or occupational therapist (OT) to complete range of motion on the hand and wrist while your arm remains in a sling. If your hand or wrist is broken, you may be allowed to complete shoulder range of motion while your cast is in place.
Ambulation and Transfers
Ambulation can be very challenging during your period of recovery if you have weight-bearing limitations on your leg. Your physical therapist will educate you on the proper sequencing of foot steps to help you ambulate farther and more safely while maintaining your weight-bearing limitations. Total adherence to your weight-bearing recommendations is vital to your recovery as over weight-bearing will risk any surgical interventions and can displace your fractured bone again.
