wrist and hand fracture and disloc Flashcards
what is barton’s fracture
fracture of the distal end of the radius involving the intra articular joint of the radius and its adjoining carpal bones
what is boxer’s fracture
fracture at the neck of the 5th metacarpal bone
what is chauffeur’s fracture
avulsion fracture of the distal end of the radial styloid process
what is colle’s fracture
fracture of the distal end of the radius resulting to dinner fork deformity
what is smith’s fracture
fracture of the distal end of the radius accompanied by fracture of the ulnar styloid process
intervention scenario in rehab for distal fractures
- restore - rehab
- compensate - to function indep
- preventive - tightness, contractures and LOM
goals in protection phase in distal fractures
0-6 wks
control swelling
limit stiffness
promote functional use of hand and other jts
interventions to control swelling
elevation of hand above heart level - pillow
encourage active mob - fingers should move
compressive stocking and tapes
interventions to limit stiffness
aggressive AROM and PROm of digits
scar massage or cross fiber
interventions to promote functional use of hand and other jts
light activities - < 5 lbs of force
AROM to shoulder, elbow; jts above and below
goals in controlled motion phase of distal fractures
6-8 wks
maximize mob
- fixations are removed
- active-assisted FA and wrist mob; esp supination
- may use dynamic splint
goals in return to function phase of distal fractures
8-12 wks
improve mob, strength and function
- continue active assisted mob
- strengthening: theraputty and small weights
discuss immob phase for wrist arthroplasty
neutral pos for several days to 2 wks
then 10-15° ext for 1-4 wks
; functional wrist pos allows function
discuss maximum and mod protection phase for wrist arthroplasty
~4 wks post op
maintain mob of unoperated jts - AROM of digits, elbow and shoulder
restore control and mob of wrist
- active wrist ext > flexion kc better grip
- tendon gliding c wrist in neutral
- postpone radial and ulnar dev bcs might displace wrist
- muscle sets, isoms, manual, light resistance
discuss minimum protection phase for wrist arthroplasty
8-10 wks post op
regain functional strength - wrist extensors > flexors
simulate gripping activities
regain functional ROM - at least 15° wrist extension
discuss immob phase in MCP arthroplasty
wrist in neutral
MCP ext or neutral or slight radial dev
IPs in slight flexion
avoid or slight lateral dev only
discuss maximum phase in MCP arthroplasty
first 3 wks
active hand exercises in dynamic splint - AROM and GPS of MP, PIP and DIP
avoid lateral pressure of thumb on digits
discuss moderate and minimum phase in MCP arthroplasty
~3 wks if stable na
full active ROM
- MCP ext
- 45-60° flexion of index and middle
- 70° flexion of ring and little; for grip
active radial dev of fingers - to faci locking of grip
discuss management of PIP/DIP arthroplasty
start ROM
- central slip sparring: 1-3 days post op
- central slip splitting: 3-5 days post op
pos of immob and exercises depends if swan neck or boutonniere’s
goal is 70° PIP flexion and full ext
avoid lateral stresses to jt
post op guidelines for boutonniere deformity
maintain PIP ext - in extension orthosis for 3-6 wks
early DIP flexion ex c PIP stab in ext
AROM or AAROM PIP flexion and ext 10-14 days post op or sooner
precautions for post op boutonniere deformity
avoid hyperextension of DIP
for central slip splitting - avoid resisted ex and stretching of extensors of PIP for 6-8 wks as long as 12 wks
post op guidelines for swan neck deformity
maintain PIP in 20-30° flexion and DIP in ext - static digital orthosis
AROM of PIP and DIP several days post op
DIP ext ex c PIP jt in slight flexion
stab DIP in neutral during PIP ROM
PIP flexion and DIP ext
precautions for post op swan neck deformity
limit PIP ext to 10° flexion during ex to avoid excessive stretch to volar aspect
avoid extreme flexion of DIP
post op guidelines for 1st CMC arthroplasty
initially avoid opposing thumb to little finger - lateral movements to thumb should be avoided
in stretching - apply force on 1st metacarpal not on phalanx
