From the Guidelines
Rehabilitation for a displaced fracture should prioritize surgical fixation to realign the bone fragments, followed by a structured rehabilitation program to promote optimal bone healing and prevent complications. The most recent and highest quality study, 1, suggests that surgical treatment of displaced clavicle fractures results in equivalent or improved short-term patient-reported outcomes and reduced rates of nonunion or symptomatic malunion when compared with nonsurgical treatment. Initially, rest and immobilization with a cast, splint, or brace are essential for 4-8 weeks depending on the fracture location and severity. Pain management usually involves NSAIDs like ibuprofen (400-800mg three times daily) or acetaminophen (500-1000mg every 6 hours) for mild to moderate pain, with short-term opioids sometimes prescribed for severe pain in the first few days. Some key points to consider in the rehabilitation process include:
- Early rehabilitation focuses on gentle range of motion exercises and isometric contractions to maintain muscle tone without stressing the fracture site.
- As healing advances (typically 6-12 weeks post-injury), progressive weight-bearing and strengthening exercises are introduced, gradually increasing resistance.
- The final phase emphasizes functional exercises specific to daily activities and occupation requirements.
- Throughout rehabilitation, proper nutrition with adequate protein (1.2-1.6g/kg body weight daily), calcium (1000-1200mg daily), and vitamin D (600-800 IU daily) supports bone healing.
- Physical therapy sessions typically occur 2-3 times weekly for 6-12 weeks, with daily home exercises, as supported by 1. It's also important to note that patient education and participation in the rehabilitation process are crucial, as emphasized in 1, to ensure a successful recovery and prevent future complications. Overall, a structured approach to rehabilitation, combined with proper medical treatment and patient participation, can promote optimal bone healing and improve outcomes for patients with displaced fractures.
From the Research
Displaced Fracture Rehabilitation
- The management of displaced fractures requires careful consideration of immobilization methods, such as splints and casts, to ensure proper recovery 2.
- Splints are noncircumferential immobilizers that accommodate swelling, making them ideal for acute musculoskeletal conditions, including displaced fractures 2.
- Casts, on the other hand, provide superior immobilization but are less forgiving and have higher complication rates, making them generally reserved for complex and/or definitive fracture management 2.
Immobilization Duration
- Research suggests that shorter periods of immobilization may lead to better functional outcomes for non- or minimally displaced distal radial fractures 3, 4.
- A study comparing 3 weeks versus 5 weeks of cast immobilization found that patients in the 3-week group had significantly better patient-reported outcomes after 1-year follow-up 3.
- Another study found that 1 week of cast immobilization followed by gradually increasing wrist mobilization resulted in no clinically significant differences in function, pain scores, and patient satisfaction compared to the usual care of 3-5 weeks 4.
Rehabilitation Approaches
- Manual physical therapy following immobilization has been shown to be effective in improving functional outcomes and reducing pain in patients with stable ankle fractures 5.
- An impairment-based manual physical therapy approach targeting associated impairments in the lower limb resulted in statistically significant and clinically meaningful improvements in self-reported function and ankle range of motion 5.
- Rehabilitation following immobilization should focus on regaining wrist movements, addressing edema reduction, and incorporating scar management, modalities, joint mobilization, and strengthening to maximize the patient's functional result 6.