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Orthopaedic Section, Gardiner General hospital, Chicago, Illinois
1950 by The American Orthopaedic Association, Inc.
J Bone Joint Surg Am, 1950 Oct 01;32(4):910-924
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One hundred and fifty-eight soldiers with femoral-shaft fractures and forty-one with condylar fractures treated on the Orthopaedic Service of Gardiner General Hospital were Subjects of an investigation to determine the effectiveness of progressive-resistance exercises in restoring knee function compared with that obtained by less strenuous physical therapeutic methods. Of patients with shaft fractures, eighty-eight received progressive resistance exercises three weeks or more, and seventy did not. Eighteen of the forty-one patients with condylar fractures received progressive-resistance exercises while twenty-three did not. All data were collected immediately before discharge from general hospital care, which in this particular hospital included, in many instances, advanced reconditioning.

Results evaluated objectively provide strong evidence of the therapeutic effectiveness of this exercise technique over less strenuous methods. For optimum results it should be initiated as soon as union permits, and continued until maximum functional gains have been made. With caution, the exercises may be initiated at the end of the immobilization period. Progressive-resistance exercises are advocated as an adjunct to more conservative therapeutic procedures, for, when integrated properly in the rehabilitation period, a superior result will usually be obtained. It should replace the less strenuous exercises which are erroneously employed at this phase of recovery. Passive and light-resistance exercises are of little or no value in the reestablishment of normal muscle bulk and strength without which rehabilitation of a fractured femur, or any other fracture for that matter, is incomplete.

The results of the study clearly indicate that as a whole, knee function, following battle-sustained fractures of the femur treated by the methods described, is not good and leaves much to be desired. The results, even in the simple, uncomplicated femoral fractures, should stimulate more interest in techniques, such as the intramedullary fixation, which would permit early ambulation to preserve knee-joint motion.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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