Rehabilitation

What happens as I recover?

Although bone and muscle healing cannot be hurried and will happen if you do nothing, restoration of normal function is very much affected by what you do. If you do too much too early you can interfere with healing. If you do nothing, recovery of strength and function of the limb may be delayed or even prevented.

Protection

In the early stages the focus of rehabilitation is on protection of the fracture from further injury. You may need crutches to allow you to get around while preventing weight bearing through the fracture.

Recovery

In the next stage you and the physical therapist will work together towards recovering function as quickly and safely as possible.

Range of motion


Movement of joints nourishes the joint surface and reduces the chance of wear. Immobile muscles and tendons tend to stick to each other or to bone while they are healing. This contrasts with the need to keep bone still while it heals to prevent break down of the healing tissue (callus). If the fracture is stable or has been fixed you may be encouraged to recover the range of motion of the limb as early as possible.

Strength

Recovering the strength of injured muscles requires exercise that puts stress on the broken bone. It must, therefore, await the later stages of bone healing. Once hard callus or consolidation of the fracture is noted you can start on a vigorous program of exercise in the gym or at home focused on muscle strengthening. This is not the same as sport. Generally return to sport must come after recovery of muscle strength.

Function

Ideally you should be able to return to the level of function you enjoyed before the injury. This outcome depends on so many factors that it doesn’t always occur. Severity of injury, motivation, bone healing in good alignment, full restoration of strength, and range of motion, and pain relief all affect the level of function after injury. Return to work and sports at the previous level with no functional impairment is more common than not, but takes hard work.

Prognosis

Prognosis is the term doctors use for the likely outcome of an injury or illness.

Untreated

Very few fractures are completely untreated. Usually they are painful enough to force you to rest the limb and avoid stressing it. Minor nondisplaced fractures which are just treated by rest will usually heal and go on to a good recovery. The risk is that an unprotected fracture will displace further before it heals. With more major fractures the untreated prognosis is poor. Without proper treatment the risks of failure to heal (nonunion), healing in a poor position (malunion), stiffness, weakness, post traumatic arthritis, and loss of function are significantly higher.

Treated

With appropriate treatment the prognosis following a fracture depends to a much greater extent on the severity of the injury. If half the bone is blown away the outcome will be poor no matter how good the treatment. Less dramatically but more commonly, the prognosis depends on damage to the joint surfaces, the degree of comminution, the eventual alignment of the bone, the time it takes to obtain healing, bone infection, and the severity of the soft tissue injury. Fixing the fracture to allow for vigorous early rehabilitation has markedly improved the prognosis.