injuries and poisoning
Overview of Fractures
Rehabilitation and Prognosis for Fractures
Most injuries heal well and result in few problems. However, some do not completely heal even though they are diagnosed and treated appropriately. How long a fracture takes to heal varies from weeks to months depending on Type of fracture Location of the fracture The person's age The presence of disorders that may delay healing For example, children heal much faster than adults, and certain disorders (including those that cause problems with circulation, such as diabetes and peripheral vascular disease), slow healing. People usually feel some discomfort during activities even after a fracture has healed enough to allow them to put their full weight on the injured part. For example, after about 2 months, a fractured wrist may be strong enough to use. However, the bone is still being rebuilt (remodeled). Thus, forceful gripping with the wrist may be painful for up to a year. Some people also notice that the injured part is more painful and stiffer when the weather is cold. Being immobilized makes joints stiff, and muscles weaken and shrink because they are not used. If a limb is immobilized in a cast, the affected joint becomes stiffer each week, and eventually people become unable to fully extend and flex their limb. Such problems can develop quickly and become permanent, usually in older people. After wearing a long leg cast (upper thigh to the toes) for a few weeks, the muscles usually shrink so much that people can insert their hand into the formerly tight space between the cast and their thigh. When the cast is removed, their muscles are very weak and look noticeably smaller. To prevent or minimize stiffness and to help people maintain muscle strength, doctors may recommend surgery ( Surgery [ORIF]) because after surgery, people are able to move the injured part relatively soon. Doctors may also recommend daily exercise, including After the fracture has healed sufficiently, the cast can be removed, and people can start exercising the injured limb. When exercising, they should pay attention to how the injured limb feels and avoid exercising too forcefully. If the muscles are too weak for people to exercise them or if such exercise could re-separate a fractured bone, a therapist moves their limbs for them (called passive exercise—see figure). However, ultimately, to regain full strength of an injured limb, people must move their own muscles (called active exercise). People who are over 65 are more likely to fracture bones for the following reasons: They may have Osteoporosis , which makes fractures more likely. Some Changes in the Body With Aging in balance, vision, sensation (mainly in the feet), muscle strength, and control of blood pressure make older people more likely to fall. In older people, blood pressure tends to drop excessively when they sit or stand up, causing They are less able to protect themselves during falls. They are more likely to have side effects of drugs (such as drowsiness, loss of balance, and dizziness), which can make falls more likely. In older people, fractures often affect the ends of long bones, such as those in the forearm, upper arm, lower leg, and thigh. Fractures of the pelvis, spine (vertebrae), and wrist are also common among older people. In older people, recovery is often more complicated and slower than it is in younger people because Older people usually heal more slowly than younger adults. Older people typically have less overall strength, less flexibility, and poorer balance than younger people. Thus, compensating for the limitations caused by a fracture is harder, and returning to daily activities is more difficult. When older people are inactive or immobilized (by casts, splints, or bed rest), they lose muscle tissue more quickly than younger adults, Thus, immobilization can lead to muscle weakness. Sometimes muscles become permanently shorter, and scar tissue forms in tissues around the joint such as ligaments and tendons. This condition (called joint contractures) limits movement of the joint. Older people are more likely to have other disorders (such as arthritis or poor circulation), which can interfere with recovery or slow healing. Even minor fractures can greatly interfere with older people’s ability to do normal daily activities, such as eating, dressing, bathing, and even walking, especially if they used a walker before the injury. Immobilization:Being immobilized is a particular problem in older people. In older people, being immobilized is more likely to cause Blood clots (as occur in Deep Vein Thrombosis (DVT) ) Pressure Sores None Muscles and Body Fat None Deterioration in physical conditioning Pressure soresdevelop when blood flow to an area is cut off or greatly reduced. In older people, blood flow to a limb may already be reduced. When the weight of an injured limb rests on a cast, blood flow is reduced even more, and pressure sores may form. If bed rest is required, pressure sores can develop on areas of skin that touch the bed. These areas should be diligently inspected for any sign that the skin is breaking down. Because immobilization is more likely to cause problems in older people, treatment of fractures focuses on helping older people return to daily activities as quickly as possible rather than making sure that the fractured bone is perfectly aligned. To shorten the time people are immobilized and to help them return to daily activities sooner, doctors are increasingly using Treatment . People are instructed to move and walk (usually with help of a walker), often as soon as the first day after surgery. Physical therapy (for example, 