Conservative treatment of injury

CLZlomeninaAs a conservative treatment we label nonoperative treatment in case where surgical treatment is one of the options. It depends to extent on a recommendation of the doctor, what type of treatment to choose. Although if you don’t suffer from acute conditions which are life threatening, then even patient has the option to choose the type of treatment. The decision should always be made when the patient heard all the informations and possibilities about a therapy from the doctor, about the pros and cons of the operation.

In the following article we will try to explain you what conservative is.

CONSERVATIVE TREATMENT OF FRACTURES

If you suffer from a fracture, the primary goal of the therapy is perfect repositioning (shifting the bone fragments back to the original position) of the broken bone. In case the fracture is not dislocated (without any shifting) the area is usually fixed with cast. The fragments of the broken bone need to be put back into the original place, if possible without surgical intervention. That is done by shifting and counter shifting. According to the need it can be performed with local or general anesthesia. It is very important that the repositioning would be done as fast as possible, ideally within the day of the injury. Afterwards, the injured segment is fixed with a cast, with a shift (movement traction with tendency for redislocation) or transfixation (fixing the fragments with a wire and afterwards with a cast). The disadvantages of the conservative treatment is long lasting immobility of the affected area due to weakened muscles, shortened muscles, restricted movement in the joints and weakened bone structure (risk of increased breaking of the bone in the future). By fractures which heal much longer, it is possible to increase the metabolic activity of the cells, and speed up the recovery process by using the focused shock wave therapy.

More about the shock wave therapy by unhealed fractures.

CONSERVATIVE TREATMENT FOR INJURED TENDONS

With completely torn tendons the usual only way is through surgery. Furthermore, it will be contemplated whether the affected muscle will serve the same way as before and how significantly damaged is the affected muscle, and whether the tendon should be sewed together or not. During conservative process, the limb is fixed (usually with a cast) in the best optional position in order for the ends of the tendons to grow back together, which can take up to 6+ weeks. This therapy is used when the patient cannot be operated, for example if the patient suffers from heart diseases or other health complications, where the surgical intervention would be highly risky.

CLoperaceCONSERVATIVE TREATMENT OF INJURED LIGAMENTS

When you are deciding between operation and conservative treatment we take in mind the age of the patient, level of movement activity, eventual injuries, level of joint instability and even motivation of the patient.

If the patient is in a productive age, physically active, it is better to undergo the operational solution. Same process is chosen in case the patient suffers from too big joint instability (declining, dislocation of the joints during daily life activities like walking etc…) or if the patient suffers from joint injuries (meniscus, muscle tendons…). The primary goal of the conservative treatment is to lower the pain and occurring edema. According to the injured area, it is decided whether it is necessary to fix the affected area (1 week after the injury). During a rupture of the front cruciate ligament isn’t fixing necessary. The affected area is usually fixed if the internal lateral collateral ligament is severely injured. At the same time, if the ligaments in the ankle are ruptured, it is ideal to fix the ankle joint as well for at least 4-6 weeks. In all the cases we should ease the pressure on the joints, by using crutches for example, or wearing shoulder sling.
Rehabilitation comes into action, after the acute phase fades out. The effort is put on to gain back the normal movement range in the joints, original muscle strength and improve the joint sensation. At the same time we focus on the single movements (correct movement stereotypes), not just in the affected area, but also within the context of the whole body. Current physiotherapy offers countless of methods and options in order to affect the disorders of the patient, based on the clinical examination and also goals of the daily activities. By injuries which heal much longer, it is possible to increase the metabolic activity of the cells, and speed up the recovery process by using the focused shockwave therapy.



Author: 
FYZIOklinika physiotherapy Ltd., Prague, Czech Republic

Source: POKORNÝ, J., aj. Traumatologie. 1. vyd. Praha: Triton, 2002. 307 s. ISBN 80-7254- 277-X.

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