Treatment and rehabilitation of fractures pdf

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Treatment and Rehabilitation of Fractures: Medicine & Health Science Books @ Physical Therapy for Fractures and . Treatment of the cervical herniated disc . Postural re-education and rehabilitation may include thoracolumbar mobility. PDF | Falls are one of the most common geriatric problems threatening the independence of older possible treatments and rehabilitation pathways for hip frac-.

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Treatment and Rehabilitation of Fractures - Ebook download as PDF File .pdf), Text File .txt) or read book online. carte fracturi. Treatment and Rehabilitation of Fractures by Stanley Hoppenfeld, , available at Book Depository with free delivery worldwide. Treatment and Rehabilitation of Fractures by Vasantha L. Murthy, , available at Book Depository with free delivery worldwide.

Our relationship extends over 30 years. Ralston TR. The crutches are then brought up to the step. Two steps are Lateral movement of the pelvis over the leg in stance equal to one stride see Figure A fracture is considered The clinical judgment that a fracture has healed is healed when there is progressive callus formation as based on the combination of the patient's symptoms occurs with secondary bone healing. Murthy 20 Phalangeal Fractures. JLuidotherapy heats by numbing effect by decreasing the firing rate in periph- convection and conduction and is used for the distal eral receptors.

Treatment and Rehabilitation of Fractures. Description Written by leading orthopaedists and rehabilitation specialists, this volume presents sequential treatment and rehabilitation plans for fractures of the upper extremity, lower extremity, and spine. The book shows how to treat each fracture - from both an orthopaedic and a rehabilitation standpoint - at each stage of healing.

Introductory chapters review the fundamentals of fracture management - bone healing, treatment modalities, biomechanics, assistive devices and adaptive equipment, gait, splints and braces, therapeutic exercise and range of motion, and determining when a fracture is healed. Subsequent chapters focus on management of individual fractures.

Each chapter on an individual fracture is organized by weekly postfracture time zones, from the day of injury through twelve weeks. Specific treatment strategies and rehabilitation protocols are then presented.

More than illustrations complement the text. Product details Format Paperback pages Dimensions The patient must be assessed during functional developed over the years.

The race is between fracture heal. The patient may heal so that the mechanical function of the bone-its have local pain secondary to stiffness and disuse. A fracture is considered The clinical judgment that a fracture has healed is healed when there is progressive callus formation as based on the combination of the patient's symptoms occurs with secondary bone healing. The fracture is in the remodeling stage.

The patient may bear weight. On examination. Bridging callus has obliterated most of the fracture line. The medullary canal and callus will remodel with time. Radiographic evaluation focuses on callus formation ing and negative sequelae such as loss of fracture as well as the blurring or disappearance of the fracture reduction.

The goal of fracture treatment is for the fracture to discomfort. These changes. The clinical along with the clinical findings. The absence of ical knowledge of how long each fracture takes to heal motion in the presence of tenderness indicates a heal- remain the mainstay for evaluating fracture healing. Historical knowledge plays a major role in fracture dence of callus because they have less motion.. One difficult task is identifying a delayed union or tures tend to heal with little visible external callus nonunion.

For Another factor is the extent of overall trauma.

Pdf rehabilitation treatment and of fractures

Age also plays a The location of the fracture also affects the type of role in fracture union: In contrast. For example. The example. In such quate periosteal coverage see Figure Stable metaphyseal frac.

Only by knowing the type and severity of because of stable interdigitation and impaction of the the fracture can the clinician truly assess if a fracture is fracture fragments as well as minimal periosteal pres. Intracapsular cases. Each fracture has a general time line for is necessary to induce callus formation see Figure healing and. Sometimes the patient's ence see Figure When a fracture is Bone healing in fractures that heal with callus for- treated with a stress-sharing device.

Compression plating is an exam- A stress-sharing device permits partial transmission ple of this type of treatment. Stress- based on either stress-sharing or stress-shielding shielding devices result in primary bone healing with- devices. The biomechanics of fixation is and there is no motion at the fracture site. The rate of bone healing. Early weight bearing is allowed if the fracture pattern is stable.

Stress sharing allows transverse midshaft fracture of the tibia. The joint above and the joint below the developed to prevent displacement. These devices are Once the fracture develops callus. This rigid fixation formation and fairly rapid secondary bone healing.

Reamed nails are frequently fractures Figures An prevents shortening and rotation at the fracture site. Even stati- allows the joints above and below the fracture to cally locked nails allow for some early weight bearing. Weight bearing is allowed to ing them very strong. Reamed nails the blood supply in the intramedullary canal. They may be These plates are stress.

They allow for weight is borne by the hardware. Frequently used to stress-shielding device. They are used less frequently than reamed nails.


In time. Secondary support of the Figures Unreamed nails are most because they have been shielded from stress and have often used with open fractures. Primary bone healing occurs because of the rigidity of the fixation. Compression plates are used most frequently in the tion. Before fracture healing.

Treatment and Rehabilitation of Fractures : Stanley Hoppenfeld :

They may be used in a a reduced blood supply see Figures l7 and Principles of Fixation Devices I 15 Unreamed nails are smaller in diameter and therefore under the plate is under diminished load. If fixation is not rigid. Because primary bone healing is a Compression plates are narrow.

Of treatment fractures pdf and rehabilitation

These devices are often used in ankle. They are all stress- stress-sharing devices. The patient is initially kept from sharing devices that allow micromotion at the frac- weight bearing Figure Weight bearing is usually delayed. These devices may be used independently or with another type of fixation.

Buttress plates are nonthreaded K-wires and pins. They are thin metal devices that provide partial immobilization used in conjunction with lag and wood screws to create at the fracture site. A sliding hip screw fracture site. This device is also used to treat subcap- delayed Figure It is usually a stress-sharing device.

When the screw is with intertrochanteric fractures of the femur. It is most frequently used distal or lateral part of the fracture. This device is used most frequently for intertrochanteric fractures. Because tightened. The smooth barrel of the screw crosses the at the proximal end of the femur.

This is a stress-sharing to have the fracture rigidly fixed Figure The fixator also avoids exces- sive soft tissue dissection because the pins are placed percutaneously. When rigidly fixed. These proximally and distally placed pins eliminate the need to place metal at the fracture site and therefore do not increase trauma to the bone in the area of the fracture. Motion of the soft tis- sues may also loosen the pins.

This is a stress-sharing device because site and externally united to stabilize the fracture. The external fixator may be used on any of the long bones of the body Figure This allows the fracture to be fixed and the soft tissue injury to be accessible for wound checks and treatment. Pins are placed above and below the fracture the distal femur. Endurance is the ability to do the same movement Active Range of Motion repeatedly.

Examples of endurance full or partial available motion on his or her own volI- exercise include walking for increasing distances. The basic principle of Functional Range of Motion strength training is to use resistance and repetitive con- Functional range of motion is the movement required traction to promote recruitment of all muscle motor from a specific joint for the performance of activities of units. The purpose of active range of motion exercise is repetitively contracting the gastrocnemius after a tibial to prevent loss of available movement at the joint.

Fast-twitch fiber atrophy is first seen as knee has a range of motion of 0 to degrees full a loss in strength. All motion is provided by. Some stabil- The movement of a joint through partial or full ity at the fracture site. The best exercise to improve bone healing when there is no or little stability at the the performance of a task is the repeated performance fracture site.

This is done until a sense of flexion is not full. The following types of exercises are most In this exercise. These are important to improve the patient's ability to perform a given func. An example of this is the leg a baseball. Direct patient sensory feedback helps to of the task itself. Unused muscles atro- of a given joint as defined by its anatomy. Muscle strength is basically the ability of the muscle to contract against resistance. To sit comfortably. This is achieved by repetitive exercise until The patient is instructed to move the joint throug?

With immobilization. Range of motion may be full anatomIc or functional the movement required to perform a spe.. These exercises consist of joint movement without cific task. Active Assistive Range of Motion tion or task. A range of motion at strengthened by extending the knee against progres- the knee from full extension 0 degrees to 90 degrees of sively heavier weight.

The muscle has normal strength. Muscle strength is types. Muscle fiber length is con- full range of motion against gravity. Strengthening exercises are of various cussed separately in each chapter.

These exercises Grade I-Trace: The muscle cannot demonstrate are indicated when voluntary muscle contraction is "movement.

Grade III-Fair: The purpose of this exercise sufficient strength to move a joint through the full is to maintain or increase the available motion at a range of motion against the force of gravity. The muscle lacks able because of pain. These exercises Although uncomplicated fractures do not present neu. Isometric exercises are very useful when the strength of a muscle is to be maintained or increased but the movement of the joint is Grade II-Poor: The joint has a full active range of either contraindicated because of fracture instability or undesir- motion after gravity is eliminated.

This is not dis. Isometric exercise is very useful when the gravity with some resistance 3-Fair Complete range of motion against gravity 2-Poor Complete range of motion with gravity eliminated l-Trace Evidence of slight contractility. Muscle testing is a geared to increase the potential tension that can be pro- useful guide for evaluating the improvement in muscle duced by contractile and static elements of the mus- strength during the recovery period. Strengthening exercise is immobilization.

Grade IV-Good: Indicates that partial resistance by the examiner can be overcome as the muscle moves through the full range of motion. Because of the Grade O-Zero: The muscle shows no evidence of con- decreased direct sensory feedback to the patient. The the joint's entire range of motion. These exercises are also referred to as set exercises. This chance of disturbing the stability of the fracture site. Progressive resistive exercises are one exam- pain. This is a dynamic exercise form using a constant load or resistance but uncontrolled speed of move- ment.

Isokinetic Exercise This exercise provides joint movement at a con- Isotonic Exercise stant rate. Examples include contracting the quadriceps muscle Progressive resistive exercises.

Pdf of treatment fractures rehabilitation and

These exercises are most frequently prescribed for increasing strength in intermediate and late stages of fracture reha- bilitation. The advantage of isokinetic exercise is that speed of movement.

These motion Figure To maintain a constant rate of motion. Isotonic exercise is a dynamic exercise performed resistance is varied in response to the muscle force using a constant load or resistance. This is the earliest type of strengthening exercise ple of isotonic exercise.

During this exercise. These exercises are prescribed ill the late stage of rehabilitation when there is good stability at the fracture site. High-Performance Strengthening Exercise The disadvantage of isokinetic exercise is that it Closed-Chain Exercise requires the use of a machine.

The muscle can be optimally strengthened through the joint's entire range of motion. Closed-chain exercises are Cybex machine can be used to strengthen the quadri. There is a "traditional" or short- that required for routine activities of daily living. Examples of this type of exercise include knee to raise the body up a step Table In this exercise. Because of the torque generated at a lower extremity fracture site.

They are used to increase overall cardiopulmonary function Open-Chain Exercise rather than to treat deficits after a specific fracture. Conditioning exercises increase endurance.

Common conditioning exer- cises include riding a stationary bicycle or using a Plyometric Exercise treadmill. This exercise is performed by maximal muscle con- traction after a quick stretch. Concentric In concentric contraction. They are performed at an adequate target heart rate for more than 20 minutes.

Rehabilitation considerations for specifying fracture. In addition to muscle fiber hypertrophy. Muscles contracting in a con- These exercises increase performance while increas.

Examples of closed-chain exer. This type of strengthening exercise is more com. Examples include leg muscle metabolism. Application to Pathological Motion. Lindelow G. Svensson K.

Acta squat is an eccentric. Rehabilitation of fractures. Muscle fibers shorten in concentric con- apart. Eccentric contractions generate greater heat as well Ceder L. They carry a greater risk of postexer. Borquist L. Statistical prediction of as greater force. The normal func. Mehta Arun JMB. Acta Orthop Scand. When exercises are prescribed as Delisa J.

Physical Examination of the Spine and Extremities. Rehabilitation Medicine: Principles and Practice. In isometric contractions. Reiker O. Effect of physical activity on muscle and exercises should be specified only when there is good bone blood flow after fracture: Soderberg G.

An Baltimore: Isometric Philadelphia: Thomgren KG. Physical Medicine and Rehabilitation. Orthop Scand. Costs of hip fracture: Eccentric change length in isometric contraction. The biceps contracts concentrically while the triceps Braddom R. Norkin C. Levangie P.

During eccentric contraction. Clinical Orthopaedic Rehabilitation. Modalities all have a predictable biologic elasticity. Skin and Pain and muscle Burn or anesthetic area Common subcutaneous tension Peripheral vascular disease Paraffin bath.

Heat increases the metabolic rate and circulatory essary to be familiar with the specific physiologic demand at the area to which it is applied and. Just as with pharmaco.

Fractures treatment pdf rehabilitation of and

It also reduces the firing rate of both muscle effect when externally applied. It is nec. Indications for its use include treatment of Superficial Heat postfracture contracture and subcutaneous adhesion. Because of this. This tem because it may interrupt system electronics.

Hot packs and radiant heat heat lamps implanted metal or a pacemaker or drug delivery sys- are used to heat the skin and subcutaneous tissues. The air. In the later upper extremity hand and wrist after fracture. The con- Heating may be applied directly using hot packs traindications to the use of ultrasound are somewhat thermal energy or by converting ultrasound acoustic controversial. Short-wave and microwave diathermy are infrequently used because of limited The degree of weight bearing.

In addition to the thermal effects. It should cold pack. The use of cold such as ground com husks is suspended by warm versus heat for pain reduction is patient specific.

Indications for its use include postfracture muscle or have a tenuous vascular supply. Superficial heating methods do Indications for its use are limited to postfracture mus- not effectively reach muscle. Hydrotherapy may include whirlpool or therapeutic Paraffin baths and fluidotherapy may provide either pool treatment.

The benefits of therapeutic heat and exercise are treatment method and parameters. Indications for this modality include pain and loss of distal upper extremity hand Cold.

Cold produces its Like paraffin immersion. Short-wave diathermy selectively heats subcuta- neous tissue more effectively than superficial heat modalities. Hot packs and ultrasound are the heating heat concentration could lead to a bum or disruption of modalities most commonly used during postfracture fracture healing.

JLuidotherapy heats by numbing effect by decreasing the firing rate in periph- convection and conduction and is used for the distal eral receptors. The general uses of hydrotherapy are to: Although it is possi.

Treatment and Rehabilitation of Fractures

It is contraindicated when there is A paraffin bath. This is the most common form of heat prescribed Short-wave diathermy is contraindicated when there is after fracture.

With phases of rehabilitation. Improve range of motion. DeLisa J. State of the Art Spray and stretch therapy consists of slow. Statistical prediction of stimulate the quadriceps after a distal femur fracture. If there is persistent pool is a good way to advance weight bearing. In select instances. Reviews in Physical Medicine and Rehabilitation.

Thorngren KG. Electrical stimulation may be provided as part of a strengthening program after a fracture has healed. Treatment in a walk-tank or therapeutic followed by manual stretching.

The stance phase. It is divided into two phases. A careful assessment of gait identifies problems that result in inefficient or limited ambulation and allows for their Stance Phase treatment. Figure Gait stance and the swing phase. The goal of rehabilitation of lower extremity frac- to be exact.

At this point. When the clinician evaluates the quality ing ambulation. Heel strike: The heel of the foot touches the essential for the practitioner to understand all aspects ground. There are two components of push-off: Foot -flat occurs as the entire the weight line passes directly over the foot at mid-stance. Push-off occurs as the weight-bearing ground. As the body progresses forward.

Foot-flat occurs as the entire plantar during double stance see Figure As the body continues to move ante. When the heel is lifted.

Double stance: Both feet are on the ground. There are two com. Gravity assists the extremity in a forward swing. The first component of swing phase is acceleration. Swing phase starts at the end of under the body and moving forward by momen- push-off when the toes lose contact with the tum Figure At mid-swing.

During acceleration. The first component of the swing phase is acceleration Figure Swing phase starts at the end of push-off as the toes lose contact with the ground. As the leg approaches the terminus of its arc of motion. At mid-swing.. Understanding the gait cycle facili- TABLE Components of the Gait Cycle tates the identification of gait abnormalities and treat- Standard Classification Alternate Classification a ment goals in the 1ater stage of rehabilitation.

If normal flexion and pelvic movement do not allow this functional limb length change. Toe-off Hip: Because the principal goal of prevents a terminal snap and positions the extremity rehabilitation after a fracture of the lower extremity is to accept weight as it approaches heel-strike. Mid-stance Hip: Gait Analysis: Normal and Pathological Function.

The Heel-strike Initial contact muscles that are the most active during each phase of Foot-flat Loading response the gait cycle are presented in Tables and Although this is Acceleration Hip: As the leg approaches the terminus of that may affect the fracture. Understanding of when and how muscles During mid-stance and mid-swing.

Most of the muscles involved are active at the begin- centric and eccentric fashion see Table and ning and the end of the stance and swing phases. Table summarizes the muscle tract in an eccentric rather than a concentric manner activity frequently considered during gait retraining see Table This may be significant if the torque after fracture.

Chapter 4. Stride length in. This is particularly impor. Step length normal: It is widened until the late stage of rehabilitation to increase the base Parameters of Gait of support and stability after fracture Figure Step length in.

The following parameters of gait-step angle. Stride length is the distance measured from heel tant after hip fracture. Step Width tion. Because of pain. Fractures of the femur or tibia disrupt the nor- walking.

In frac- tured limb and shorter for the uninvolved limb. The parameters of gait must be normalized to restore Hirr-Knee-Ankle Movement cosmetic. Speed Pelvic Rotation Normal walking speed is approximately 2.

Speed slows with either reduced cadence or a The pelvis rotates medially anteriorly as the swing decrease in the step or stride length. Step length is initially longer for the frac. If ing fully erect. Hip fractures and hip surgery impair the nor- present in the early and intermediate stages of rehabil. Flexion at the hip and knee and dorsiflexion of the ankle serve functionally to shorten a limb.

After decreasing the height needed to clear the swing-phase fracture. These movements can all be thought of as increasing or decreasing the functional length of a Knee Flexion in Stance lower extremity. Fractures of the hip or lumbar spine impair or extremity length is occasionally disrupted. This limits the maximum height a person achieves eral and vertical up-and-down motion while walking. The net effect of this is to decrease The determinants of gait are the movements that vertical movement and concomitant energy cost while improve efficiency.

Two steps are Lateral movement of the pelvis over the leg in stance equal to one stride see Figure Knee flexion in stance is abnormal with. Cadence This both decreases the vertical amplitude of movement Cadence.

This decreases as a result of pain. The opposite rotation lat- length. After fracture. The determinants of gait limb shortening during swing because of reduced include pelvic tilt. Stride Length Stride length is the distance measured from heel Pelvic Shift strike to heel strike of the same foot.

Pathologic changes in gait after a lower extremity the patient may use trunk extension before heel strike fracture occur as a consequence of shortening. This may fracture. The patient ture. A decrease in efficiency Figure A patient with a weak glu- to minimize the time spent on the fractured limb. Ankle and subtalar motion reduces energy cost by reducing the amplitude of movement and smoothing Short-Leg Gait the translation of movement.

Although the gait remains abnormal in such an instance. Vaulting Gait An analysis of the determinants of gait becomes The patient may plantar flex the short limb.

Antalgic Gait This painful gait IS an attempt to avoid bearing weight on the fractured lower extremity. If gluteal weakness persists. This is the uncompensated gluteus maximus lurch. If weakness or shortening persist. The opposite "long" leg may be other soft tissue contracture. Step length is reduced after any fracture of the lower extremity. This may be due to pain. Once a fractured limb is fully weight bearing. This teus maximus muscle may experience difficulty in preventing flex- may result from pain or anxiety and almost invariably ion of the trunk at heel strike and may use trunk extension gluteus follows any fracture of the lower extremity.

In an antalgic gait. Ankle and foot fractures If shortening has occurred after a lower extremity prevent normal ankle motion during gait. When actual shortening due to bone loss or functional shortening due to muscle shortening Gluteus Maximus Lurch e. This throwing of the trunk to the side of the impaired gluteus medius is gluteus medius lurch. If this lurch persists. Less frequently.

To clear the foot during swing phase. A weak gluteus medius is ineffective in preventing the drop of the opposite hemipelvis dur- ing swing phase. To compensate. FIGURE Steppage gait may occur from nerve or soft tissue trauma that leaves the patient unable to dorsiflex the foot in the swing phase. Description The ideal companion to Drs.

Hoppenfeld and Murthy's acclaimed reference, "Treatment and Rehabilitation of Fractures", this superb CD-ROM provides one-click access to the full illustrations from the text. Because the CD-ROM uses a Power Point format, you'll find it easy and practical to adapt the many line illustrations for use in your own presentations, lectures, and courses.

It's also a great way for orthopaedists and physical therapists to review treatment options with patients! Rating details. Book ratings by Goodreads.