A. Causes

• Mechanism: Trauma (e.g., fall, direct impact) causing discontinuity of the bone.
• Types: Various types (e.g., simple, compound, spiral, comminuted).
• Treatment: Managed conservatively (casting/bracing) or surgically (ORIF).
• Immobilization: Required period of immobilization leads to secondary muscle wasting and joint stiffness.

B. Symptoms

• Pain: Residual pain at the fracture site and surrounding joints.
• Stiffness: Severe stiffness and limited range of motion in the affected and adjacent joints.
• Swelling (Edema): Persistent swelling in the distal limb (e.g., hand/foot).
• Weakness: Significant muscle atrophy and inability to activate muscles effectively.

C. Diagnosis

• Clearance: X-ray confirmation of radiological union (bone healing) is mandatory before intense loading.
• Assessment: Quantifying the loss of active and passive range of motion.
• Strength Test: Assessing muscle strength to quantify atrophy and weakness.
• Gait/Function Test: Assessing the ability to bear weight and perform functional tasks (e.g., gripping, reaching).

D. Physiotherapy Treatment Plan

• Immediate Goal: Control persistent swelling using elevation, compression, and massage.
• Mobility Restoration: Aggressive but controlled range of motion exercises and joint mobilization to combat stiffness.
• Scar Management: Mobilizing any surgical incision to prevent adhesion and soft tissue restriction.
• Strengthening (Early): Starting with isometrics and gentle bodyweight exercises to reverse atrophy.
• Weight Bearing: Strict adherence to the surgeon’s PWB (Partial Weight Bearing) progression protocol.
• Proprioception: Balance training and sensory re-education, especially for lower limb fractures.
• Functional Training: Integrating strengthening and mobility into specific, job-related or sport-related tasks.
• Patient Education: Managing expectations regarding the timeline for strength recovery and return to activity.