Fracture

Most fractures unite. What determines the outcome is what happened to the joint above and below during immobilisation, how much muscle was lost, and whether the person regained the confidence to load the limb.

This is why rehabilitation starts during immobilisation rather than after it — with the joints that are free to move, the other limb, and general conditioning.

Weight-bearing status and any range restriction come from the treating surgeon and differ by fracture pattern and fixation. Non-weight-bearing, touch weight-bearing and partial weight-bearing are different instructions and the difference matters.

We ask for the operation note and the protocol in writing. Where a patient arrives without them, we contact the surgeon rather than infer from the fracture name.

Wrist fractures commonly leave stiffness and grip weakness, and finger stiffness develops fast if the fingers are not moved from day one. Ankle fractures leave stiffness and calf weakness that limit walking long after union.

Hip fractures in older adults are a different category — they are a marker of frailty and falls risk, and rehabilitation addresses bone health, falls prevention and sarcopenia alongside the hip itself.

Increasing pain rather than decreasing, particularly with disproportionate swelling, burning pain, colour or temperature change and extreme sensitivity to light touch — these suggest complex regional pain syndrome, where early treatment matters.

Numbness, a limb that is cold or discoloured, wound discharge or fever all need same-day assessment.

Prolonged immobilisation costs substantial muscle and joint range, and in older adults it costs bone as well. The fracture heals on its own timetable; everything around it deconditions on a faster one.

This is why rehabilitation begins during the immobilisation period rather than after it — the joints above and below, the other limb, and general conditioning are all trainable while the fracture is protected.

Early mobilisation, then training of walking, balance and everyday tasks. The NICE hip fracture guideline recommends a physiotherapy assessment and, unless there is a medical or surgical reason not to, mobilisation on the day after surgery, followed by mobilisation at least once a day with regular physiotherapy review 3.

A 2022 Cochrane review of 40 randomised trials with 4,059 participants, whose average age was 80, found that mobility training after discharge from hospital led to small but clinically meaningful gains in mobility and walking speed, and it rated that evidence as high certainty 2. Programmes that trained gait, balance and functional tasks were particularly effective 2. Two limits matter: most of the trials excluded people with cognitive impairment, and the training appeared to make little or no difference to mortality or hospital re-admission 2.