Q: Doctor my son is 22-year-old, he had an accident and had his thigh bone fractured. Kindly guide me about the physiotherapy for the fracture.
A: Thigh bone fractures are common injuries that occur in motor vehicle accidents or any other traumatic event. It is important to know that inadequate treatment can lead to limb shortening and even deformities. A physiotherapist will assess the patient in an inpatient or outpatient setting according to the condition, surgical procedure, and chronicity of the case. Radiographs including X-rays and sometimes CT scans are required for assessment. Normally 3 to 6 months are required for a fracture to heal properly but more time can be required for patients with co-morbidities. Physiotherapy starts in an inpatient setting and the patient is allowed to bear weight as tolerated, The Patient is guided to start walking when appropriate by using walkers or crutches.

Physiotherapy aims to improve impairments after a femoral shaft fracture i.e. address weight bearing (WB) status, knee effusion, quadriceps control, and hip abduction strength. The program needs to be dynamic, incorporating interventions designed to target these known impairments, helping to restore normal muscle strength, joint motion, and flexibility. Whilst in the hospital, a therapist will teach the patient how to use a walking aid to allow them to mobilize, depending on their weight-bearing status. Gait training results in increased bone formation. Even if gait training is completed using 30-50% of body weight support, an increase in bone formation could be found. Phases of Treatment: Initial phase (week 0-2): Treatment includes gentle passive and active movements and gait training using an assistive device. Also, education to get in and out of bed, on and off the toilet, and up and down the stairs. Soft tissue mobilization may be used to help decrease pain levels and improve range of movement. The patient should be taught a basic range of movement and strengthening exercises to maintain a degree of strength and reduce the risk of blood clots. Begin with a range of motion exercises for the hip, knee, and ankle. During the immobilization period, the therapists need to actively mobilize the foot, with or without weight. The use of isometric exercises is also important to train the muscles (quadriceps, hamstring & glutei) of the upper leg. Functional quadriceps exercises should be initiated as soon as possible after the surgery because the quadriceps help provide stability in the knee. Flexion exercises also need to start as soon as possible, provided the fracture is adequately supported (i.e. the selected fixation approach allows for weight bearing). Middle phase (week 2-6): The goal is to strengthen the quadriceps, hamstrings, and gluteal muscles. The exercises are progressed as the surgeon/physiotherapist sees fit to ensure they are carried out safely and efficiently. Late phase (weeks 3-12): Aim to gradually return the patient to their function/sporting activity with exercises focusing on sport-specific drills. Restoring ability with ADLs eg. walking to the shops, household cleaning, and gardening, Hydrotherapy is an excellent way to maximize mobility, strengthen muscles and stretch tight muscles (only appropriate when your wound has healed. Development of exercises to continue strengthening muscles around your hip. Exercise will also improve balance, flexibility, and endurance. Activities to increase your fitness levels may be included such as walking, hydrotherapy, and gentle cycling. Physiotherapy should be continued until an acceptable functional range has been achieved or until a static position has been reached. It is necessary to record the range of movements in the knee with accuracy; first, this should be done weekly and then at monthly intervals. Strengthening exercises based on the surgeon's orders typically begin at six weeks post-op. Balance and proprioceptive rehab are important as these abilities are quickly lost with inactivity. After the consolidation therapists need to focus on: the revalidation of the gait cycle; more intense mobilization, strength-training therapy to reverse the muscle atrophy that occurred during the immobilization period, and condition training to increase the loss of endurance during the immobilization period.

Q: I am a 33-year-old female and cannot move my wrist in an upward direction properly, I got an injection that was administered incorrectly. I have been experiencing the problem since then.
A: The condition is known as “Wrist Drop”, which is caused by damage to the Radial nerve. The nerve supplies the muscles that are responsible for moving the elbow, wrist, and fingers in extension. It also controls sensations of the arm, damage to the nerve can cause paralysis of the muscles, and there can be weakness, numbness, and sensory issues.

A physical therapist conducts a detailed neurological examination for assessment of the condition, utilizes stimulatory modalities (for facilitation), and plans exercises for rehabilitation.