Heera vijayakumar¹, Diker Dev Joshi²

Author:

²Lecturer, Padmashree Institute of Physiotherapy, Bangalore, Karnataka, India

Corresponding Author:¹Professor, Padmashree Institute of Physiotherapy, Bangalore, Karnataka, India, Mail id: heerapt1977@gmail.com

ABSTRACT

INTRODUCTION  

A 48 year old female patient named Niveditha who was housewife by profession presented with pain on pubis and upper back region along with right shoulder and right area of chest. History of present illness showed that on 6^th December 2018, patient went to pond to immerse a god idol after a prayer when a tractor passed through half of her body. She was immediately shifted to BGS global hospital Kengeri, Bangalore, where X ray was taken and it was found that she had multiple fractures of ribs, pelvis, neck of femur and both pubic rami. Along with that she had also sustained injury on the spine of scapula. But all the fractures were found to be stable. Her shoulder was immobilized in a sling for a week whereas, for remaining fractures painkillers and calcium tablets were advised by Orthopedician¹. She was then started on physiotherapy protocol.

METHODOLOGY

Before the physiotherapy treatment pre values were taken for Pain using VAS scale, MMT for muscle power of shoulder and hip and functional Independence through Functional Independence measure ^2,3,4.  Physiotherapy was started with ankle toe movements⁵, limited Range of Motion exercises for right upper and lower limbs and full ROM exercises for left upper and lower limbs⁶. Patient was advised for bed rest to prevent pressure sores and she was kept in air Bed⁷. For the fingers, patient was given a sponge ball and was advised to squeeze it at least 3 times a day (1 set of 10 repetitions each time) ⁸. As patient was depressed she was given psychological counselling⁹. The patient had mild pleural effusion for which she was given incentive spirometry (1 set of 10 repetitions each time) twice a day¹⁰.

On 3^rd week the repeat X ray was taken on which it was seen that fractures were not healed completely. The shoulder sling was removed and trunk rotation exercises were started carefully with 15 degrees of spinal rotation¹¹.  

On 4^th week, patient’s preparation for sitting was started. Initially patient was bought to inclined position by placing 2 pillows over her entire back to avoid the postural hypotension, which could have occurred had the patient been brought to 90° supine lying directly. The numbers of pillows were weekly increased to increase the inclination. By 8^th week patient was made to sit 90°.After that the patient was slowly brought to long sitting¹².

Once long sitting was achieved, high sitting training was started¹³. Then sitting to standing practice was started for the patient with the support from the physiotherapist¹⁴.Once the patient was comfortable in standing position she was made to stand for more time with the help of walker and it was followed by walking few steps with the help of walker¹⁵.Slowly the patient could walk herself with the help of walker.

On 8^th week, a repeat X ray was done which showed healed fractures. The patient was then taught weight lifting and weight bearing exercises¹⁶. The patient started walking without any walking aids. At this stage the post outcome measures scores were taken [Table 1] which showed good improvement. Patient was already off the medications except calcium tablets and she was not taking even painkillers. The patient was than taught home exercises and regular physiotherapy was stopped.

Ethical Clearance: Ethical clearance has obtained from BGS Global hospital Kengeri, Bangalore to conduct this study.

Conflict of interest: There was no conflict of interest to conduct this study.

Fund for the study: It was aself financed study.

CONCLUSION

Early physiotherapy intervention is quite helpful for improving the functional independence of patient even in multiple fracture case. ROM exercises, Bed Mobility, Trunk rotation exercises, functional reeducation along with psychological counselling can help  a great deal to make the patient independent.

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