Evaluation indicators for functional recovery after bone plate fixation

The evaluation of functional recovery after bone plate fixation is the core link of rehabilitation treatment. It is necessary to quantify the functional status of patients through multi-dimensional indicators to guide the adjustment of rehabilitation plans. The following are the key indicators for functional recovery assessment and their clinical significance:

First, pain assessment

Degree of pain

Visual Analogue Scale (VAS) : Patients score on a scale of 0 to 10 based on the intensity of pain. A score of 0 indicates no pain, and a score of 10 indicates severe pain.

Clinical significance: Early postoperative pain should gradually ease. If the pain score remains ≥4 points or worsens at night, it may indicate loosening of the internal fixation, infection, or excessive rehabilitation training.

Nature of pain

Distinguish between sharp pain (which may indicate internal fixation stimulation) and dull pain (mostly due to muscle fatigue or inflammation). Different types of pain require targeted treatment.

Second, Range of Motion (ROM)

Active and passive activity levels

Active range of motion: The range of joint movements independently completed by the patient, reflecting muscle strength and nerve control ability.

Passive range of motion: The range of joint movement completed with the assistance of external force, reflecting the flexibility of soft tissues such as the joint capsule and ligaments.

Clinical significance: Passive range of motion should be restored first in the early postoperative period, and active range of motion should be gradually increased in the later period. The ultimate goal is to achieve more than 90% of the range of motion of the healthy side joint.

Standard for recovery of joint range of motion

Upper limbs: Shoulder joint flexion ≥150°, elbow joint flexion and extension ≥130°, wrist joint flexion and extension ≥70°.

Lower limbs: Hip flexion and extension ≥110°, knee flexion and extension ≥120°, ankle dorsiflexion/plantar flexion ≥30°.

Third, muscle strength assessment

Bodyweight muscle strength Test (MMT

The muscle contraction ability was evaluated by using the 0-5 grade classification method:

Level 0: Complete paralysis

Level 3: Complete full-range movement against gravity;

Grade 5: Normal muscle strength.

Clinical significance: Muscle strength may drop to grade 2-3 in the early postoperative period and needs to be gradually restored to grade 4-5 through progressive resistance training.

Isokinetic muscle strength test

Muscle strength was quantified through an isokinetic muscle strength tester to evaluate the ratio of muscle strength between the affected limb and the healthy side, with the goal of recovering to more than 80% of the healthy side.

Fourth, Activities of Daily Living (ADL)

Basic ADL assessment

The Barthel Index was used to assess the ability of patients to independently complete daily activities such as eating, dressing, washing up and using the toilet, with a full score of 100. A score of ≥60 was considered as basic self-care.

Instrumental ADL assessment

Evaluate the patient’s ability to use complex activities such as transportation, shopping, and cooking to reflect social participation.

Fifth, gait Analysis (Lower extremity Fractures)

Gait cycle parameters

Step length: The difference in step length between the healthy side and the affected side should be no more than 2cm.

Walking speed: The normal walking speed is 1.2-1.4m/s. After the operation, it should gradually recover to more than 90% of the healthy side.

Gait symmetry: The proportion of bilateral weight-bearing was analyzed through the distribution of plantar pressure, with the goal of a bilateral weight-bearing difference of ≤5%.

Abnormal gait recognition

Lameness: It may be caused by pain, insufficient muscle strength or joint stiffness.

Shortening of the supporting phase: indicates insufficient weight-bearing capacity of the affected limb.

Sixth, imaging and biomechanical assessment

Fracture healing condition

Observe whether the fracture line disappears and whether the callus formation is continuous through X-ray or CT. After confirming the fracture healing, gradually increase the weight-bearing.

Internal fixed state

Check whether the bone plates are deformed and whether the screws are loose to avoid secondary fractures caused by the failure of internal fixation.

Joint stability

The stability of structures such as joint ligaments and meniscus is evaluated through stress position X-ray or MRI to prevent traumatic arthritis.

Seventh, psychological and social function assessment

Psychological state

The Self-Rating Anxiety Scale (SAS) or Self-Rating Depression Scale (SDS) was used to assess the psychological state of patients. Anxiety or depression may affect rehabilitation compliance.

Social participation

Evaluate the patient’s ability to return to work and social activities to reflect the ultimate goal of rehabilitation.

Eighth, phased goals for functional restoration

Early goals (0-6 weeks after surgery)

Pain control, recovery of passive joint range of motion, and isometric muscle contraction training.

Medium-term goals (6-12 weeks after surgery)

Recovery of active joint range of motion, enhancement of muscle strength, and partial weight-bearing training.

Late-stage goal (more than 12 weeks after the operation)

Full weight-bearing, functional training, return to daily life and social activities.