Fractures

Question 1

Healing timeline for fractures

Answer 1

• Inflammatory phase (1-2 weeks): hematoma forms on the fracture site, tissues come together to begin bone repair
• Regeneration phase (2-6 weeks): regrowth of bone and vascular tissue, soft callus turns to hard callus and direct union occurs
• Remodeling phase (6 weeks-1 year): strong bone tissue (ossification) is at the fracture

Question 2

OT’s role in fracture management

Answer 2

• Splinting
• Edema control
• Pain control/modalities
• Regain ROM (progress in this order: gentle AROM, AAROM, PROM, stretching)
• Regain sensation

Question 3

Choices for fracture fixation

Answer 3

• Stable fractures will often have closed methods of fixation, such as a cast or splint
• Displaced or unstable fractures will require some form of internal fixation
• External fixation used when traction is needed to hold a fracture out to length

Question 4

Complications associated with fractures

Answer 4

• Adherence of tendons
• Joint stiffness/contracture
• CRPS

Question 5

Treatment for non-displaced radial head fracture

Answer 5

• Sling for a few days
• Elbow flex/ex with forearm in neutral
• Supination and pronation with elbow at 90 degrees flexion
• AROM at week 3 as tolerated
• No resistance for 8-10 weeks

Question 6

Types of distal radius fractures

Answer 6

• Colles: dorsal angulation of radial head; more common; median nerve often affected
• Smith: volar angulation of radial head

Question 7

Ulnar abutment syndrome

Answer 7

• Normally a 22-degree incline between ulna and radius exists–syndrome occurs when this is out of alignment (often due to shortening of radius after fracture)
• Increased pressure in TFCC due to larger amount of force distributed to ulna than normal
• Presents with ulnar-sided wrist pain, pain with weight-bearing and power grip, and pain with supination (ulna migrates distally with supination)

Question 8

Kienbock’s disease

Answer 8

• Avascular necrosis of lunate

- Often from extra pressure that lunate takes due to ulnar abutment syndrome

Question 9

Physical intervention for distal radius fractures

Answer 9

• Closed reduction for non-displaced and where joint surface is preserved
• Surgical fixation methods: arthroscopic pinning, volar or dorsal plating and screws
• Cast applied for two weeks, then wrist control splint (AROM can start, begin in gravity-eliminated)

Question 10

Treatment for scaphoid fracture

Answer 10

-If stable, immobilization by casting (thumb spica) for 6-8 weeks

Question 11

Symptoms of scaphoid fracture

Answer 11

• Pain in snuffbox
• Limited ROM due to pain (esp. extension and RD)
• Decreased grip strength
• Painful grip and pinch

Question 12

Healing timeline for scaphoid fracture

Answer 12

• Distal third: 6-8 weeks
• Middle third: 8-12 weeks
• Proximal third: 12-24 weeks (due to retrograde blood flow, will require ORIF)

Question 13

Treatment for fractures of the digits

Answer 13

• Closed and non-displaced: splint, cast, or buddy tape
• Closed and displaced/angulated: manipulation/reduction of bone and immobilization with cast or splint, percutaneous pinning, or external fixator
• Open, displaced, intra-articular, comminuted: internal or external fixation

Question 14

Fracture consolidation within the hand

Answer 14

• Metacarpals: 3-5 weeks
• Proximal phalanx: 5-7 weeks
• Middle phalanx: 10-14 weeks
• Distal phalanx: 3-4 weeks