Patient Management Post-Fracture Flashcards
Types of Bone Healing
Primary and Secondary
Primary Healing
Direct contact between fragments
Occurs two weeks from injury
Rigid compression fixation
No callus formation
Stable fracture site
Secondary Healing
Callus formation
Occurs with casting and external fixation
Most common type
Motion minimized but not eliminated
Stress-sharing Fixation Devices
Not rigid fixation
Callus formation
Faster healing
Examples include: casts, intramedullary (IM) nails, external fixators
Stress-shielding Fixation Devices
Rigid fixation
No callus formation
No motion at fracture site
Examples include: plates, compression screws
Plate Fixation Device
The only stress shielding device
Primary healing (no callus)
Slow rate of healing
Late weight bearing status
Requires secondary support
Cast, Rods and External Fixator Devices
All stress-sharing devices
Secondary healing
Fast rate of healing
Early weight bearing status
Pin, Screws or Wires Device
Stress-sharing device
Fast rate of healing
Delayed weight bearing status
Frequently used with other fixations
Fracture Healing Considerations/Factors
Who: age of patient
What: type of fixation, severity, degree of trauma
Where: location of fracture, extra or intracapsular, site blood supply
When: time frame
Why/how: mechanism of injury (MOI)
Phase 1: Protected Motion
Immobilization
ROM of non-involved joints above and below
WB status
Edema control
Education
Phase 2: Early Motion
WB status
Immobilization - Discontinued vs. partial use
Continue phase 1 interventions as needed
Begin joint ROM
Address other impairments (Non-involved joints, Wound/scar, Function)
Phase 3: Functional Recovery
WB status
Immobilization usually discontinued
Continue phase 1 and phase 2 interventions as needed
Progress to full joint ROM as tolerated
Begin strengthening (Isometrics -> isotonics)
Begin neuromuscular reeducation
Address functional deficit (transfers, stairs)
Phase 4: Return to Activity
Return to full functional mobility
ADLs, Household chores, Recreational activities, Work
Effect on Healing: Medications
NSAIDs - inhibit prostaglandin formation (necessary for fracture healing)
Corticosteroids - inhibits Ca absorption, also may inhibit collagen production, extracellular matrix molecules, and granulation tissues
How does Diabetes affect fracture healing?
Decreased tensile strength of callus (in rats)
Delayed bone healing
