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Fractures of the apophysis of the femur and the tibia is intra-articular injuries. Distinguish isolated fractures of the femoral condyles (as the tibia), when damaged medial or lateral bone, and fractures of both condyles. In the latter case the line of fracture may have a T or V-shaped. Treatment of fractures of the condyles of the femur and tibia predominantly conservative. For isolated fractures of the condyles after reduction of fragments apply a plaster cast (for a period of 4 weeks), in fractures of both condyles resort to a skeletal traction for a period of 4 to 6 weeks with the subsequent imposition of a plaster cast for 3-4 weeks. In complicated fractures osteosynthesis is performed with screws, biloba nail or bolt. In fractures of one of the condyles of the axial load allows in 2-2,5 months, in fractures of both condyles is in 3-4 months. Physiotherapy start on the second day after injury.
The immobilization period, the tasks of exercise therapy is to improve blood and lymph flow to stimulate regenerative processes, preventing the formation of intra-articular adhesions, muscle atrophy, rigidity of the joint. In classes include General developmental exercises, covering all muscle groups, and breathing exercises; exercises that enhance the basic function of the intact lower limb; active static and dynamic exercises, with resistance and light weights to strengthen the muscles of the shoulder girdle and upper limbs; exercises to train the vestibular apparatus. For the injured extremity are recommended movement in the joints free from immobilization, ideomotor exercises and isometric muscle tension femur and tibia. In the early days of immobilization to better relax muscles and improve circulation, especially blood flow, it is not necessary to achieve intense muscle tension femur and tibia, in isometric conditions. For training the peripheral vessels need several times during the day to lower an injured leg, giving her exalted position. 1-2 weeks is shown dosed walking with crutches (with the unloading of the injured extremity).
In postmobilization period therapeutic exercises aimed at increasing range of motion in knee and ankle joints, strengthen the muscles of the thigh and lower leg, arch of the foot, mastering the skills of movement with crutches. In the first days after removal of immobilization motion in the knee joint perform in lighter conditions (practicing under the limb should follow up on the sliding surface, the foot lock roller on the carriage with the help of a practitioner). Exercises are performed in the initial position lying on your back, stomach, side and sitting. On the background of respiratory and General tonic exercises special perform active finger movements of the foot, active movement in the knee and hip joints, back and plantar flexion of the foot, circular foot movement, isometric muscle tension femur and tibia, static hold straight limbs, abduction and adduction of the limb. It is recommended to increase the duration of the walk with crutches: patients not only moves within the chamber and compartment, they are allowed to climb the stairs, walk on the hospital grounds. In this period it is impossible to give an axial load on the injured limb. Shown exercise in warm water.
In the recovery period, tasks of medical gymnastics is the full restoration of knee function, strengthening muscles and supporting ability of the limb. Physical exercises performed from different starting positions - lying, sitting and standing. Walking with partial load on the injured limb, it is useful to exercise in the pool. Classes are conducted 4-5 times a day, increasing the number of repetitions for each exercise. You should pay attention to the patient on the correct formulation of the foot during walking and posture. In the process of learning the walk it is advisable to use an inclined shield or other device to measure the load on the lower limbs. With incomplete range of motion in the knee joint shown mechanotherapy. Massage of the limb is recommended only for the full completion of the consolidation process.
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