Post-Fracture Rehab

Three main problems after a fracture:

• Joint stiffness — soft tissue tightens during immobilisation; the joint above and below the fracture often limits more than the fracture site itself. A wrist fracture affects the shoulder and fingers too; an ankle fracture stiffens the toes and knee.
• Muscle weakness — surrounding muscles shut down quickly during immobilisation. A 6-week cast can mean 30–40% strength loss without structured rehab.
• Functional confidence — the patient doesn't trust the limb yet. Fear of re-injury keeps people guarded, and that guarding prevents normal loading, which slows recovery.

Physio addresses all three in parallel: graded range, progressive strength, and confidence-building through task practice. Some cases — especially hip fractures in older adults — also need falls-prevention work to stop it happening again. workplace-injury insurance-covered cases often need coordinated documentation alongside the clinical work.

First session 45–60 minutes, RM 80–180 in a Seremban or Nilai private clinic — higher end if a brace or splint is being fitted. Home visits for older adults post-hip fracture RM 150–300.

Bring: the discharge summary, post-fracture X-rays (or the report), any splint / brace, the surgeon's protocol if surgically fixed.

Expect: a review of the fracture site and mechanism; range-of-motion assessment of the fracture joint AND the joints above and below; strength assessment of surrounding muscles; swelling and scar tissue check; functional task testing (grip for wrist, walking for ankle / hip, reaching for shoulder); and a graded home programme. Good physios send video clips of the exercises on WhatsApp so you can check form. Re-assessment every 2–3 sessions with objective measures (goniometry, grip dynamometer, functional tests) tells both of you whether the plan is working.

Ranges local physios use with patients:

• Distal radius (wrist): 8–16 sessions over 6–12 weeks after cast removal; grip and wrist range usually return well
• Ankle (malleolus, ORIF): 12–20 sessions over 3–4 months; weight-bearing phases depend on the surgeon's protocol
• Tibial plateau: 3–6 months; delicate weight-bearing progression matters
• Hip neck fracture (older adult, often after a fall): 3–6 months; often includes falls-prevention component
• Shoulder proximal humerus: 3–4 months; regaining overhead reach is the hardest part
• Clavicle: 6–12 weeks
• Metacarpal / phalanx (hand): 4–8 weeks; often co-managed with a hand therapist

Re-testing every 2–3 sessions on range, strength and a functional task tells you the plan is working. If progress stalls, the physio should coordinate with the orthopaedic surgeon at KPJ Seremban Specialist Hospital, Columbia Asia Seremban or NSCMH Medical Centre — imaging might be repeated, or a different rehab approach tried.

Continue physio if pain is reducing, range is progressing, and follow-up X-rays show good healing. Most post-fracture patients make steady progress with the right plan.

Go to A&E at Hospital Tuanku Ja'afar — not a physio — if any of these appear: sudden increase in pain at the fracture site, especially with swelling or deformity (possible re-displacement or non-union); calf swelling and pain after lower-limb fracture (possible DVT — high risk after long immobilisation); fever with red, hot, painful site (possible infection — particularly after surgical fixation); sudden numbness or weakness distal to the fracture (possible nerve compromise); inability to bear weight that was previously OK. Any concerns after a recent surgical fixation should go direct to the surgical team at KPJ Seremban Specialist Hospital, Columbia Asia Seremban or Mawar Medical Centre first.