ORTHOPAEDIC REHABILITATION · Health guide
Rehabilitation and Movement Training After Fracture
When does rehabilitation begin after a fracture? Union, permission to bear weight, joint stiffness and planning the return to daily life.
Updated: · General information
The fracture healing process
A fracture is a break in the continuity of bone and/or cartilage; medically there is no distinction between a “crack” and a “fracture” — what is popularly called a crack is usually an undisplaced fracture. Healing takes place in three stages: the inflammatory phase (1–2 weeks, with swelling and haematoma formation and clearance of damaged tissue), the reparative phase (which may last months; the soft callus of fibrous tissue, cartilage and bone hardens into hard callus, and problems at this stage can lead to delayed union or non-union), and the remodelling phase (which may last months to years, as immature bone is converted into more organised, solid bone).
How is rehabilitation planned?
The programme is determined by the site of the fracture, the surgical fixation and the state of healing. There is no fixed weight in kilograms for loading that applies to everyone; the orthopaedic team’s recommendations are the reference. Movement, strength and balance work is planned in stages for the joints that are suitable. For return to work or sport, functional capacity is assessed alongside union of the fracture.
Maintaining the balance
The fundamental principle of the process is to hold immobilisation and mobilisation in the right balance, so as to prevent complications and return safely to pre-injury function; this balance is planned and monitored jointly by the physician and the physiotherapist.
The state of union and permission to bear weight
The site of the fracture, the method of fixation and the orthopaedic reviews set the limits of the programme. The removal of a cast does not mean that all loading is permitted. The operation report and the recommendations from the most recent review should be brought to the assessment; the permitted level of movement and weight bearing is clarified between the teams.
Working with stiffness and loss of strength
After a period of immobility there may be swelling, joint stiffness and reduced muscle strength. Range of movement and everyday use are built up in stages. An unexpected increase in pain, a problem with the wound or new numbness requires the programme to be reassessed. For return to sport, strength and control are considered alongside union of the fracture.
Your questions
Patient information
If the pain has eased, can I bear full weight?
The decision on weight bearing is not based on pain alone. The limits set by orthopaedics, according to the fracture and the fixation, must be observed.
Should forceful stretching be done as soon as the cast comes off?
No. The dose of movement is set according to tissue healing and the examination; trying to force the joint open is not appropriate.
