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Dr 文科生 By Dr 文科生

2019-08-08 12:55:39 有 656 人按讚
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最近香港好多市民受傷，有物理治療師為大家提供了以下骨折護理資訊，設計師亦好好人幫我們設計了infographic。

《上肢骨折後治療及護理》

以下資訊由註冊物理治療師提供，只作參考之用，並不構成醫療咨詢。

一般來說，上肢骨折後處理分為兩大類

【一】保守治療(Conservative Approach)
【二】手術治療(Surgical Approach)

保守治療一般適合於未有移位的骨折(non-displaced fracture)。治療方法大多會以工具固定關節，例如

【1】石膏(Plaster cast)，讓骨折部份自然癒合。

【2】可拆式手托(Removable cast) 通常適合於骨裂(hairline fracture)

【3】肩膊的部份骨折也可以使用肩托(Shoulder immobilizer)固定

固定時間一般為四至六星期，視乎骨折程度，臨床情況及X光診斷而定。

手術(Surgical approach) 大致指以手術方式用金屬釘、板或線將骨折部份拼好，然後讓骨折部份癒合。K-wire fixation，IM nail fixation，open reduction and internal fixation (ORIF) 等都是常見手法

這都是醫生根據骨折的位置、類別而決定，情況就如用釘槍將兩塊木板合併一樣。一般來說，K-wire 會在四至六星期移除，其餘則因應情況決定

即使手術後，醫生也會為患者配置不同固具以作初期保護，一般使用時間為二至四星期。

《保守還是手術方案好？》
如果只是骨裂，非移位或非常輕度移位骨折，保守處理都可以讓骨折復原並沒有受金屬部件或手術後疤痕(稍後討論)影響。

但骨折有移位、外露或者骨折形成了一定數量的碎片，保守處理未能確保復原時， 手術固定就會是較好的方案。

———————————————————
《固定期間/手術後注意事項》

【1】避免濕水

不論石膏或手術固定，都要避免濕水以防皮膚潰爛或感染手術後傷口。傷者洗澡前應以垃圾膠袋將患處及石膏包好，再用保鮮紙封好邊位
洗澡時應盡量舉高患處，以減少水從身體流到患處。盡量避免用花灑直接淋向膠袋邊口
在戶外時若遇大雨可用膠袋包好稍作保護

【2】盡量活動未有固定的關節

根據骨折的位置，被固定的關節可能會多於一個。因為患處被固定期間，肌肉亦被固定，日常的肌肉亦大減，很快會出現肌肉萎縮的問題。

為減少肌肉萎縮的問題，請不時活動其他未有被固定的關節，並盡可能活動到該關節的最大活動範圍。

【3】不要對止痛藥有所忌諱，請按需要以建議劑量服用。

醫生會因應臨床情況處方多過一種不同類型的止痛藥。當中可分為定期服用類(Regular)及突發性服用類(Breakthrough)

定期服用類的止痛藥建議跟隨醫生意見準時服用，盡量避免劇痛才服。

定期服用止痛藥可確保體內有一定程度的止痛藥，減少因疼痛而影響日常生活以及活動。

突發性服用類止痛藥為定期服用的止痛藥外額外添加的止痛藥，醫生會因應臨床情況而決定。如病人的痛楚過大而未能進行物理治療，醫生或會建議於物理治療前服用。

正確服用止痛藥可以令傷者更有效地作早期活動(Early mobilization)以及改善睡眠質素，都對康復有很大裨益。

*** 早期活動對康復治療進程舉足輕重，別為了避免止痛藥而放棄早期活動。如有有關止痛藥的疑問請向醫生或藥劑師查詢。

【4】如果打石膏時，石膏內腫得十分壓迫

請不時將患處放於高於心臟位置，以減低血壓及引流組織液，如果長時間十分壓迫，請盡快約見醫生。

【5】打石膏/手術後可做運動，倒如健身單車嗎

除早前提及的避免濕水外，拆石膏及傷口未復原前盡量避免會大量出汗的運動。

即使只是上肢受傷，跑步或跳躍等動作可能會導致患處疼痛，所以骨折初期盡量避免劇烈運動

———————————————————

《拆石膏後/手術傷口復原後注意事項》

【1】適當潤膚

數星期的固定很容易令死皮積聚，硬化及龜裂。除了影響活動，亦有機會引致不必要傷口，可選擇早期使用低刺激性潤膚產品。

【2】冷/熱敷?

一般來說，熱敷/浸暖水為佳，約５至１０分鐘。熱敷可以增加血液循環，並軟化表皮組織。

【3】 按摩手術後疤痕

手術是由表皮一直開刀到骨表面，當中所產生的疤痕會將表皮肌膜等軟組織釘實。關節活動時，軟組織之間或無法正常滑動，從而產生痛楚及活動限制。

情況就像公司三文治中，那枝將麵包，蕃茄，火腿，青瓜串起的牙籤一樣。所以輕輕按緊疤痕，然後向不同方向拖動(不是捽死皮)，可以幫助疤痕回復軟組織的滑動，從而減少痛楚及活動限制。

【4】去疤貼/膏
與按摩疤痕大同小異

【5】骨折復康過程

根據不同骨折的分類，嚴重程度及位置，骨折復康預期進度都有所不同。

長期疾病，生活習慣，年齡性別都會對康復進度有影響。

上肢骨折會比下肢快一點，一般6-8星期骨折會癒合，之後可以做漸進重量訓練回復本身的身體機能。

【6】 被動關節運動 (Passive mobilisation) vs 主動關節運動(active mobilisation) vs 強化運動(strengthening)

患處在固定後，一般會分為三階段活動訓練

［第一階段］

被動關節運動會在覆診時或固具拆卸後開始，主要透過治療師或其他工具去被動活動骨折及其他受影響的關節(跟平常拉筋無異)，從而減少該關節的僵硬(Stiffness)，期間該關節不需要用任何力。

［第二階段］
主動關節運動指患者用受影響關節附近的肌肉去活動關節，從而逐漸回復其關節可活動範圍。

［第三階段］
強化運動會在約八至十二星期後開始，主要針對受影響的肌肉，透過階段性的力量訓練去回復到受傷前的肌肉力量。

【7】根據醫生/物理治療師指示活動關節

【很重要】【很重要】【很重要】

其實這是根據第6點的伸延

這樣不詳述，因為每個骨折的情況可以活動的範圍也不同。根據醫生/物理治療師指示階段性活動關節可以確保骨折位置復原及減少關節僵硬。如有問題可以PM我

————————
特別嗚謝
物理治療師：古典音樂家
Infographic designer: puzzle Pixel Design

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Dr 文科生

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90後香港男生 Patreon專欄： https://www.patreon.com/user?u=32901195 Blogger in Meducia 你的健康夥伴 https://www.meducia.com/
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Open Reduction Internal Fixation (ORIF),. Involves surgical placement of implants (mainly plates and screws) to guide the healing process of.

#72. Hip Fracture Open Reduction Internal Fixation (ORIF)

The most common type of hip fracture occurs when the top of your femur, the long bone between your knee and hip, breaks. Surgery to fix this type of hip ...

#73. Metatarsal Fracture Fixation | Open Reduction | Internal Fixation

The goal of the metatarsal fracture fixation (open reduction and internal fixation) procedure is to correct a fracture of one or more of the long bones of ...

#74. Complications of open reduction and internal fixation of ankle ...

Early complications. Early complications after ORIF of ankle fractures include wound edge dehiscence, necrosis, infection, and compartment syndrome. Internal ...

#75. Open Reduction Internal Fixation (Titanium Stryker Leibenger ...

Open Reduction Internal Fixation (Titanium Stryker Leibenger Plates) of Phalanx Fracture Non Articular of the Hand One Finger Index or Thumb (Broken Hand).

#76. Open Reduction Internal Fixation of the Ankle - Merrimack ...

Severe ankle fractures that will not heal properly with splinting or casting alone, may benefit from a procedure known as open reduction internal fixation.

#77. Open Reduction Internal Fixation Poststernotomy Mediastinitis

Introduction. Mediastinitis has been reported to complicate 5% of sternotomy surgery. We have adopted an open reduction and rigid internal fixation (ORIF) ...

#78. Open Reduction and Internal fixation of Adult Distal Femur ...

Open reduction and internal fixation (ORIF) is a commonly used surgical treatment for bone fractures, including the femur. ORIF places the ...

#79. Type II Frx: Open Reduction Internal Fixation

Type II Frx: Open Reduction Internal Fixation ... fixation of the fracture with cancellous screws - butress plating of the lateral cortex; - position:

#80. Calcaneal Fracture Fixation (Open Reduction and Internal ...

Calcaneal Fracture Fixation (Open Reduction and Internal Fixation) ... In preparation for the procedure, the patient is positioned and anesthesia is administered.

#81. Distal Radius Open Reduction and Internal Fixation - Jomi.com

The primary goal of ORIF for distal radius fractures is the restoration of anatomical position and function of the wrist. Internal fixation of displaced or non- ...

#82. Lisfranc Open Reduction Internal Fixation Wayne, NJ - New ...

Orthopaedic surgeons at Northlands Orthopaedic Institute perform Lisfranc open reduction internal fixation in Livingston, Morristown, Butler, Hewitt, ...

#83. Short Term Outcomes Following Open Reduction Internal ...

Treatment groups. Key: ORIF =Open reduction internal fixation, DRF= distal radius fracture. Hand Therapy modalities were prescribed according to ...

#84. Posterior-Based Approaches to Open Reduction Internal ...

abstract. Although there is growing evidence supporting posterior-based surgical approaches to open reduction internal fixation (ORIF) of malleolar ...

#85. Open Reduction Internal Fixation (ORIF) Surgery - Dr. Ong ...

An open reduction internal fixation (ORIF) surgery is a surgical procedure to repair severely damaged bones. Learn more about what to expect during the ...

#86. Open reduction internal fixation (ORIF) of tibial plateau fracture

Patients with open tibial fractures managed with external fixation and negative-pressure wound treatment devices will return to the OR semielectively for repeat ...

#87. Femur fracture repair - discharge - MedlinePlus

These devices are called internal fixators. The complete name of this surgery is open reduction and internal fixation (ORIF). In the most common ...

#88. Open reduction and internal fixation of displaced proximal ...

Patients were included undergoing ORIF by use of locking plates for displaced two-part surgical neck type proximal humeral fractures.

#89. Arthroscopic Assisted Open Reduction Internal Fixation ...

Procedure: Arthroscopic Assisted Open Reduction Internal Fixation. Surgical fixation of ankle fractures with use of arthroscopy. Other Name: AORIF.

#90. Open reduction and internal fixation in temporomandibular ...

Meanwhile, there is a growing tendency to perform ORIF in condylar head fractures and severely displaced or dislocated fractures in younger ...

#91. Femur Fracture Open Reduction and Internal Fixation - BayCare

Open reduction and internal fixation (ORIF) is a type of surgery used to stabilize and heal a broken bone. You might need this procedure to treat your ...

#92. Metacarpal or Phalanx (ORIF) Open Reduction and Internal ...

Metacarpal or Phalanx (ORIF) Open Reduction and Internal Fixation. Dr. Bakker's Post-op Protocol. IMPORTANT INSTRUCTIONS FOLLOWING SURGERY:.

#93. Outcomes Following Open Reduction Internal Fixation of ...

Outcomes Following Open Reduction Internal Fixation of Ankle Fractures. (ORIF) By Podiatric Surgeons. Glenn M Weinraub, DPM, FACFAS1, Ian Newport, DPM, ...

#94. Outcomes of Patients With Pelvic-Ring Fractures Managed by ...

... disabilities, and handicaps of patients with multiple traumas and pelvic-ring fractures after management with open reduction internal fixation.

#95. Fracture & Trauma Treatment Fountain Valley - Coastline ...

Open reduction and internal fixation (ORIF) or external fixation (OREF) is offered at Coastline Orthopaedic Associates in Fountain Valley and Orange County, ...

#96. Mid-Term Outcomes After Open Reduction Internal Fixation of ...

Mid-Term Outcomes After Open Reduction Internal Fixation of Proximal Interphalangeal Joint Dorsal Fracture-Dislocations Through a Volar, Shotgun Approach ...

#97. Jones Fracture Fixation (Open Reduction and Internal Fixation)

Jones Fracture Fixation (Open Reduction and Internal Fixation) ... This procedure is used to correct a Jones fracture - a fracture of the fifth metatarsal bone of ...