Precautions for early activities after bone plate fixation

Early activities after bone plate fixation are a key link to promote recovery and prevent complications. However, safety principles must be strictly followed to avoid internal fixation failure or secondary injury due to improper activities. The following are the core considerations for the early activities:

First, the timing and scope of the activity

Follow the doctor’s advice strictly

Early postoperative activities should be determined based on the type of fracture, fixation method and the degree of soft tissue injury. Usually, light activities can be started 1 to 3 days after the operation, but they should be carried out after evaluation by a doctor.

Contraindications: If there are open wounds, severe swelling or a risk of infection, the activity time should be postponed.

It is mainly passive activities

Passive activity definition: Completing joint movements with the assistance of others or equipment to prevent active muscle contractions from exerting stress on the fracture site.

Example: For upper limb fractures, passive flexion and extension of the shoulder and elbow joints can be performed. Lower extremity fractures can perform passive dorsiflexion/plantar flexion of the ankle joint.

Control the range of activities

The early range of motion should be limited to a painless or slightly painful range to avoid exceeding the critical Angle for the stability of the fracture end.

Key principle: Take “not causing pain to worsen” as the limit of activity. If the pain persists for more than 30 minutes after activity, reduce the range of activity.

Second, the intensity and frequency of activities

Low intensity and high frequency

Duration of each activity: Each activity should last for 5 to 10 minutes. Do it 3 to 5 times a day to avoid fatigue caused by prolonged continuous activities.

Progressive principle: The intensity of activities should be gradually increased along with the healing process of fractures. In the early stage, the focus should be on restoring joint lubrication, and in the later stage, resistance training should be gradually added.

Avoid exerting force actively

In the early stage, active muscle contractions (such as active leg lifting or fist making) are prohibited to prevent the bone plates from being subjected to shearing or torsional forces.

Alternative method: Maintain muscle strength through isometric contractions (muscle tension without joint movement), such as quadriceps tension exercises.

Third, pain and swelling management

Pain monitoring

The pain score after activity (0-10 points) should be ≤3 points. If the pain score is ≥4 points, the activity should be stopped immediately and ice packs should be applied.

Treatment for aggravated pain: If the pain persists for more than 2 hours or worsens at night, a timely re-examination is necessary to rule out loose internal fixation or fracture displacement.

Swelling control

Apply ice packs continuously within 48 hours after the operation, each time for 15 to 20 minutes, with an interval of 1 to 2 hours.

Elevate the affected limb: After the activity, raise the affected limb above the level of the heart to promote venous return and reduce swelling.

Fourth, auxiliary tools and postures

Use braces reasonably

Select the appropriate brace (such as a cervical collar, thoracolumbar brace, or knee joint limiter) based on the fracture site. Wear the brace during movement to provide additional stability.

Brace adjustment: The tightness of the brace should be such that 1-2 fingers can be inserted to avoid being too tight and affecting blood circulation.

Posture management

Bedridden position: Avoid prolonged pressure on the affected limb. Turn over regularly (every two hours) to prevent pressure sores.

Sitting/standing position: When transitioning from a lying position to a sitting or standing position, a slow transition is necessary to avoid dizziness or falls caused by orthostatic hypotension.

Fifth, taboos and prevention of complications

Absolute taboo behavior

Prohibition of weight-bearing: In the early stage, complete weight-bearing of the affected limb is prohibited. When getting up and moving, crutches or walking AIDS should be used, and the affected limb only needs to perform the “touching the ground” action.

Prohibit torsion/lateral stress: Avoid joint torsion (such as ankle rotation) or lateral force (such as pulling the affected limb when turning sideways).

Complication prevention

Deep vein thrombosis (DVT) : Promote blood flow in the lower extremities through ankle pump movement (active flexion and extension of the ankle joint), and use anticoagulant drugs as prescribed by a doctor when necessary.

Joint stiffness: Perform passive activities 3 to 5 times a day to prevent joint capsule contracture.

Muscle atrophy: Maintain the volume of muscle fibers through isometric contraction training to prevent disuse atrophy.

Sixth, psychology and compliance

Psychological support

Early activities may cause patients to resist due to pain or fear. Psychological counseling is needed to relieve anxiety and emphasize the importance of activities for recovery.

Family participation: Encourage family members to assist patients in completing passive activities to enhance their confidence in recovery.

Compliance management

Patients need to strictly record their daily activities (such as activity time and pain score) to facilitate doctors’ assessment of rehabilitation progress.

Regular follow-up: X-rays should be reexamined at 1 week, 2 weeks and 4 weeks after the operation to observe the alignment of fractures and the stability of internal fixation, and the activity plan should be adjusted in a timely manner.

Seventh, handling of special circumstances

Infection risk

If the wound exudate increases, redness and swelling worsen, or the body temperature exceeds 38℃ after the activity, the activity should be stopped immediately and medical attention sought to be vigilant against the spread of infection.

Nerve injury

If numbness, tingling or weakness occurs in the affected limb after activity, it may be due to nerve compression or traction. Immediate immobilization and re-examination are required.

The internal fixation is loose.

If a “click” sound is heard or abnormal movement of the affected limb is felt during activity, it may be due to loose bone plate screws. Immediate immobilization and emergency treatment are required.