Physical therapy for fractures

Fracture• Fractures or loss of continuity in the substance of

a bone are a common occurrence and represent considerable treatment time and financial costs in the accident and emergency room

• It is interruption of anatomical cortical continuity of the bone cortex . Or loss of continuity of bone cortex.

• it is the breakdown of the bone into two or more pieces .

The fractures are classified into:

• Simple and compound fractures.• Stable and unstable fracture.• Displaced and undisplaced.• Complete or incomplete fractures.• According to the shape of fracture line (transverse,

oblique, spiral, comminuted and butterfly ) .• Pathological, stress, traumatic fractures

Common Types of Fractures

Diagnosis of fractures

• History• Clinical picture (pain, deformity, creaptus, swelling,

loss of function, loss of motion…..)• Examinations and special signs and tests• Investigations

Assessment of the cases

• Assess the affected area (expose and hind area)• Assess the total region• Assess the related areas• Assess the whole limb• Assess the total body

The complication of fracturesGeneral complications

1- hemorrhage2- infections3- shock4- fat embolism5- crush syndrome6- bed ridden complications

Local complications

• Bone healing complication• Nearby joints• Vessels • Nerves• Muscles • Ligament and tendons

Managements of fracturesThere are three stages in the management of fractures:

• Reduction: manipulation of the bone to its correct anatomical position

• Immobilization: a means of holding the bone in the correct reduced position

• Rehabilitation: returning the person to as full function as possible after the trauma or disease

Physical therapy program during immobilization period

1. To prevent respiratory complications → - breathing exercises. - postural drainage - teach patient the correct way of cough and huff2. To prevent circulatory complications →

- circulatory exercises - elevation if available - gentle massage if available 3. To prevent stiffness, weakness & atrophy of the free parts →

ROM exercises- strengthening exercises

4. To delay and prevent weakness of immobilized parts → static & isometric exercises

5- to prevent bed source . - changing position every 2 hours - alternating air mattress - alternating water mattress - alternating pressure mattress6- balance ex and co-ordination ex7- proprioceptive ex8- postural correction ex 9- positioning in bed

10- treatment of complication if presents 11-treatment of other physical disorders if

presents 12- preparing for ambulation by strengthen the

crutch muscle, and explain the gait with assistive devices

Physical therapy program after immobilization• Problem solving approach• Strengthening ex for weak ms• Stretching ex for tight structures• Mobilizing ex for limited ROM in certain joint • Balance ex and co-ordination ex• Proprioceptive ex• Gait training with and without assistive devices• Orthoses and prostheses• Functional rehab.

CKC EXERCISES (NWB, PWB & FWB) e.g. - mini-squats- leg press- step-ups- proprioception training- stationary bicycle

Psychological rehab. And occupational therapy

may be need

N.B

Also The rehabilitation is a complicated

process depend on all the team work members