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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 case of 48 year old female patient with multiple fractures atright shoulder, chest and Pelvis was admitted in BGS Global hospital Kengeri, Bangalore. The patient met with an accident in which a tractor passed though half of her body leading to multiple fractures. As most of the fractures were turned out to be stable the patient was given painkillers and calcium tablets and started physiotherapy after 1 week.
Methodology: Physiotherapy was started with Ankle Toe Movements, ROM exercise, sponge ball exercise, Incentive spirometry, Trunk rotation exercises, and gentle massage on the injured areas. The patient was given gait training in later stage followed by exercises in walker. Pre and post assessment taken for muscle power of shoulder and hip, Visual Analogue Scale for body pain and Functional Independent Measures to find the outcome.
Result: After 8 weeks of daily physiotherapy, the patient improved with muscle power, reduced body pain, improved body function and the patient started walking without any assistive devices.
Conclusion: With immediate physiotherapy even with multiple fractures the patients can get back to their Activities of Daily Living.
Keywords: Fracture Rehabilitation, Muscle Power,  Visual Analogue Scale, Functional Independent Measures, Activities of Daily Living,
Received on 15th August 2020, Revised on 28th August  2020, Accepted on 31st  August 2020, DOI:10.36678/IJMAES.2020.V06I03.006

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 6th 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 3rd 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 4th 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 8th 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 8th 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.

Table 1: Pre and Post Values of Outcome Measures

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.

REFERENCES

  1. Wraighte PJ, Scammell BE. (2006 Jun). Principles of fracture healing. Surgery (Oxford). 1; 24(6):198-207.
  2. Bergh I, Sjöström B, Odén A, Steen B. (2001 Oct 1). Assessing pain and pain relief in geriatric patients with non-pathological fractures with different rating scales. Aging Clinical and Experimental Research, 13(5):355-61.
  3. Aitken DM, Bohannon R W. (2001 Mar 1). Functional independence measure versus short form-36: relative responsiveness and validity. International Journal of Rehabilitation Research, 24(1): 65-8.
  4. Gajdosik RL, Bohannon RW. Clinical measurement of range of motion: review of goniometry emphasizing reliability and validity. Physical therapy. 1987 Dec 1; 67(12):1867-72.
  5. Hickey BA, Cleves A, Alikhan R, Pugh N, Nokes L, Perera A. (2017 Sep 1). The effect of active toe movement (AToM) on calf pump function and deep vein thrombosis in patients with acute foot and ankle trauma treated with cast–A prospective randomized study. Foot and Ankle Surgery, 23(3):183-8.
  6. Kisner CA, Colby LA. (2012). Range of motion Therapeutic exercise foundations and Techniques, 61-73.
  7. Biggie J, et al. (1999 Jul). Air distribution device for the prevention and the treatment of decubitus ulcers and pressure sores. United States patent US, 5; 926; 884.
  8. Magnus CR, et al. (2013 Jul 1). Cross-education for improving strength and mobility after distal radius fractures: a randomized controlled trial. Archives of physical medicine and rehabilitation, 94(7); 1247-55.
  9. Cuijpers P, van Straten A, van Schaik A, Andersson G. (2009 Feb 1). Psychological treatment of depression in primary care: a meta-analysis. British journal of general practice., 59 (559); e51-60.
  10. Overend TJ, et al. (2001 Sep 1). The effect of incentive spirometry on postoperative pulmonary complications: a systematic review. Chest; 120(3):971-8.
  11. Yamauchi T.(2015 Jun 1). The effect of trunk rotation during shoulder exercises on the activity of the scapular muscle and scapular kinematics. Journal of Shoulder and Elbow Surgery; 24(6):955-64.
  12. Ladozhskaya-gapeenko EE, et al. (2018 Jul 3). Method for treating and preventing diseases having neurological, cardiological and therapeutic profiles. United States patent US, 10; 10; 469.
  13. Arry RH. (2004 Nov). The interactional management of patients’ physical incompetence: a conversation analytic study of physiotherapy interactions. Sociology of Health & Illness. 26(7):976-1007.
  14. Hoppenfeld S, Murthy VL, editors. Treatment and rehabilitation of fractures. Lippincott Williams & Wilkins; 2000.
  15. Härdi I, Bridenbaugh SA, Gschwind YJ, Kressig RW. (2014 Apr 1). The effect of three different types of walking aids on spatio-temporal gait parameters in community-dwelling older adults. Aging clinical and experimental research, 26(2); 221-8.
  16. Yung P, Lai YM, Tung PY, Tsui HT, Wong CK, Hung VW, Qin L. (2005 Aug 1).  Effects of weight bearing and non-weight bearing exercises on bone properties using calcaneal quantitative ultrasound. British journal of sports medicine, 39(8):547-51.
Citation: Heera vijayakumar, Diker Dev Joshi (2020).Rehabilitation of a patient with multiple fractures caused by tractor running over half of body: A case Report, ijmaes; 6 (3); 825-828.

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