Long-term results of functional treatment in intraarticular knee fractures and multifragment fractures of the shaft of femurs.

Functional treatment of fractures is a nonoperative technique used in intraarticular knee fractures and multifragment and multilevel fractures of the shaft of femurs since 1974. The basic principle of this technique is placement of the fractured extremity in the specially designed rehabilitation splint, with skeletal traction fixed above the ankle joint through both tibia and fibula. Traction reduces the fracture while stretching of muscles provides conditions favorable for callus formation. Exercises are first isometric and then isotonic. During exercises, muscle tone and moments of force in each muscle group are measured to evaluate effects of exercises. Exercises in traction and rehabilitation splints are continued until clinical signs of healing are observed (i.e., for six to eight weeks with intraarticular knee fractures and ten to 12 weeks with fractures of the shaft of femur). Alternative flexion of bone fragments with their compression by the contracted muscles facilitate absorption of hemorrhage, reduces swelling, and accelerates osteogenesis by replacing passive-tissue congestion with the active-tissue metabolism. Seven hundred fifty-seven intraarticular knee fractures with 76% excellent and good results, 20% average, and 4% poor were observed with this treatment. Functional treatment was also used in 320 multifragment and multilevel fractures of the shaft of femurs, with approximately 81% excellent and good results, 17% average, and 2% poor. Functional treatment of fractures is simple and safe, promotes healing, prevents muscle atrophy, reduces contracture formation, and minimizes functional loss.