Early Mobilization and Structured Rehabilitation for Fracture Patients

Acute Phase Management (First Days–Weeks)

Initiate early range‑of‑motion exercises within the first postoperative days and progress to weight‑bearing and structured exercise programs, while avoiding overly aggressive therapy that can cause fixation failure. 1
Begin mobilization as soon as orthopedically permissible to lower the risk of thromboembolism and improve overall rehabilitation outcomes. 4
Distal radius fractures: Start finger motion immediately after casting or surgery to prevent edema and stiffness; once immobilization is removed, implement aggressive finger and hand motion to achieve optimal functional results. 1
Shoulder fractures: Commence shoulder, elbow, wrist, and hand ROM exercises within the first postoperative days; slings are used only for comfort and may be discarded as pain permits, but activities above chest level should be withheld until radiographic healing is evident. 1
Overly aggressive physiotherapy increases the likelihood of postoperative fixation failure; therapy must balance early motion with protection of the surgical construct. 1

Allow early weight‑bearing as soon as orthopedically appropriate to further reduce thromboembolic risk and shorten hospital stay. 4
Introduce physical training and muscle‑strengthening interventions early in the post‑fracture period to maximize functional recovery. 1

The primary goal is to restore the patient’s pre‑fracture level of mobility and independence, requiring early identification of individualized goals before designing the rehabilitation plan. 1
Continue balance training indefinitely as a core component of multidimensional fall‑prevention strategies. 1
Implement fall‑prevention programs, which have been shown to improve bone mineral density, increase muscle strength, and lower fall frequency. 1
Structured exercise programs improve bone mineral density and muscle strength, although direct evidence for fracture prevention remains limited. 1

Provide comprehensive education on injury burden, potential complications, fracture risk factors, and expected outcomes throughout the rehabilitation course. 3
Education should clearly outline follow‑up expectations and the anticipated duration of therapy. 3
Orthogeriatric co‑management is recommended for frail, elderly patients with multiple comorbidities and polypharmacy during acute fracture care. 1

Physical‑therapy assessment and mobilization training constitute the majority of the inpatient stay after hip fracture and must be coordinated before discharge. 4
Occupational‑therapy evaluation is required to address activities of daily living and conduct home‑safety assessments, ensuring safe discharge. 4
Social‑work consultation is essential for discharge planning and linking patients to community resources. 4
Failure to address secondary prevention—including falls prevention and osteoporosis management—leads to subsequent fragility fractures with poor prognosis. 4
Only 44 % of patients admitted from home return to their own homes within 30 days after hip‑fracture surgery, highlighting the need for comprehensive discharge planning. 4

Post‑operative cognitive dysfunction or delirium occurs in approximately 25 % of hip‑fracture patients, interrupting rehabilitation and necessitating multimodal optimization (adequate analgesia, hydration monitoring, early urinary‑catheter removal). 4
Inadequate pain control disrupts rehabilitation and raises delirium risk; regional anesthesia techniques can markedly reduce opioid consumption. 4
Up to 60 % of hip‑fracture patients are malnourished on admission; nutritional supplementation may lower mortality and shorten length of stay. 4