Week 5 - Fracture Management Flashcards
name the most common type of fracture for all ages.
distal radius fracture
name 5 risk factors of fractures.
- trauma
- increasing life span
- race
- comorbidities -osteoporosis
loss of bone continuity; force exceeds tissue strength
fracture
____ begins at time of injury.
inflammation
vascular disruption can lead to ____.
necrosis
- caused by immobility
- starts with uncorrected skeletal deformities, acute pain and persistent edema
- leads to progressive stiffness, tendon adhesions, muscle atrophy, pain, loss of function
fracture disease
Energy sufficient to fracture bone must pass through ___ ___.
soft tissue
name 4 examples of soft tissue that energy must pass through to fracture bone.
- ligament
- volar plate (fingers)
- tendons
- skin
what are the most common complication of hand fractures?
joint contracture and tendon adhesions
t/f - soft tissue can be severely damaged in both open and closed fractures.
true
-site protection and clearance
-healing process begins
0-2 weeks
inflammation stage of fracture healing
-scaffold for new bone
-soft to hard
-fluffy opacity on x-ray
2-3 weeks
callus formation of fracture healing
- bridging by cartilage/immature bone
- fracture stable but weak
- 4-6 weeks
union stage of fracture healing
- all callus replaced by bone
- immature bone becomes lamellar bone
- bone secure
- 6-8 weeks
consolidation stage of fracture healing
- continued osteoblast/osteoclast activity
- reshaping to best density and shape
- 1-2 years
remodeling stage of fracture healing
what is the first soft tissue that protects PIP joints? (very important to look at in finger fractures)
volar plate
- direct or contact healing
- when vasculature is intact
- cortical contact
- fracture fixation provides compression
- bone grows directly across compression and heals without callus
- 5-6 weeks for bone to close
primary method of fracture healing
describe the main components of the primary method of healing.
- there is compression
- no callus
- when motion across fracture site is limited but not eliminated
- callus or indirect healing
- motion is required for secondary healing and promotes callus
- wires, rods, external fixation
- they do not compress fracture gap
secondary method of fracture healing
name 3 main components of the secondary method of healing.
- callus
- does not compress fracture gap
- motion is limited but not eliminated
name 3 factors that contribute to predictable variability of fracture healing.
- location
- nature of fracture
- type of fixation
fractures from high impact/force heal more slowly due to what?
soft tissue and vascular damage
open fractures heal slower due to what?
soft tissue and bone loss
chronic bone infection
osteomyelitis
name 5 risk factors for delayed fracture healing.
- diabetes
- smoking
- long term steroid use
- NSAID
- poor nutrition
name 3 effects of immobilization on muscle
- decrease of muscle strength
- increase fatigue during work
- atrophy begins in 1-3 days
once atrophy begins, when is loss of muscle mass greatest?
within next 5 days
what % of decrease in muscle fiber size (atrophy) occurs 72 hours after immobilization?
14-17% decrease
which method of healing is ORIF plate and screws?
primary (compresses)
OTs must remember what 3 things with fracture management?
- bone
- soft tissue
- scar healing
overall goal to restore functional abilities of pt.
rehabilitation
with most fractures there will be a period of ____.
immobility
name 6 components of OT evals for fractures.
- wound, skin, scar
- pain
- ROM
- strength - MMT, grip, pinch
- hand function (dexterity)
- ADLs/work
what type of ROM should you use for pts affected joint(s)?
AROM
which types of ROM should you use for joints above and below fracture?
AROM and PROM
name 5 OT fracture guiding principles/considerations.
- is fracture stable?
- is fracture healing
- closed or open reduction?
- is edema under control?
- are tendons gliding?
describe the goals of the immobilization phase of fracture treatment.
- protect healing structures
- control pain and edema
- ROM uninvolved parts
- complications
- NO thermal modalities during inflammatory phase
how long is the immobilization phase?
4-6 weeks (may be shorter)
should thermal modalities be used during the inflammatory phase?
NO
describe the goals of the motion phase of fracture treatment.
- manage pain, edema, wound, skin, scar
- controlled motion (AROM to PROM)
- light functional activities
- monitor tissue response
- wean from orthosis
describe the goals of the strengthening phase of fracture treatment.
- increase ROM to functional levels - add PROM, stretch, joint mobilization, orthosis to mobilize joint.
- increase muscle strength and endurance
- moderate to heave tasks
describe the goals of the late phase of fracture treatment.
- work conditioning
- functional capacity eval if necessary
- return to play, sports, leisure
what should be part of treatment in all phases of fracture treatment?
pt. education!
name a protection rehab intervention for fractures.
- orthotics: plaster, fiberglass, thermoplastics
- immobilize NECESSARY joint
- prescribed by MD
name 3 pain rehab interventions for fracture treatment.
- PAMs - cold, heat, e-stim
- myofascial release
- massage
name 5 edema rehab interventions for fracture treatment.
- elevation
- compression
- ACTIVE exercise
- MEM
- cryotherapy
name 2 wound/scar rehab interventions for fracture healing.
- at pin sites or incision site.
- scar remodeling - manual mobilization, ultrasound, elastomer
name 4 ROM rehab interventions for fracture treatment.
- AROM, AAROM, PROM
- full arc of motion - not partial
- isolate target joint(s)
- may be combined with - heat, stretch and AROM
name 2 orthotics rehab interventions for fracture treatment.
- once healing sufficient to apply stress to improve certain motions with MD ok!
- orthosis usually dynamic or static progressive
motion before ___.
strength
for closed reduction fractures, you will wait longer to begin ___.
AROM
name the 3 progressive steps of strength interventions.
- motion
- strength
- endurance
name 4 factors that may delay healing.
- infection
- continued edema
- other comorbidities
- pain
name 2 modalities that are used in edema treatments.
- NMES
- cold
name 3 different types of fists used to determine if tendons are gliding.
- full fist
- hook fist
- flat fist
which method of healing is a cast?
secondary (slight movement on fracture sight)
In closed reduction cases, you will wait longer to begin ___.
AROM
name 3 factors to consider in the sub-acute phase of a healed fracture.
- edema - now may be brawny
- limited ROM - PROM to involved joints, careful passive stretching
- decreased strength
name the 4 steps of the “treatment hour” during a session.
- warm up - heat, massage, getting ready for treatment session
- hands-on period - using your hands to help pt., passive range, stretching, massage, helping them move
- independent period - pt. works on their own
- cool down - Q&A, cold packs, going over home program
