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Fractures

Break in the continuity of a bone

Type of fracture

Transverse, oblique, spiral, comminuted, avulsion, osteochondral

 Common fx names

Stage of healing

1. Hematoma within 72H of initial trauma
2.Inflammatory rxn, proliferation of osteoblasts at the periosteum
3.Soft callus or splint is formed from mass of proliferating osteoblast, repair is still incomplete
4.Consolidation occurs as the immature woven bome is changed into mature lamellar bone
This is a complete repair
5.Remodeling of the irregular outer surface and reshaping of the marrow space inside the bone take place through alternating osteoclastic and osteoblastic activity

Complications of Fx

Compartment syndrome
This can occur in the forearm and lower legs following fx

Nerve compressions
This may be indicated by paresthesia in the tissues under the cast

Untreated vascular damage
It may be indicated by an increase in observable distal red, black or blue bruising
Refer to MD!!

Bone and soft tissue infxn
This occurs from external fixation

DVT
May occur after lower limb fx especially in the veins or calf
Pain, swelling, slight heat
MC in elderly, CV pathology

Pressure or plaster sore
Compression of the cat cause ischemia one the bony prominence

Cast dermatitis
Poor ventilation and hygiene of the skin under the cast

Delayed union, non-union, malunion
Bone doesn't unite properly or unite not preferred way, or delayed

Myositis ossificans
Bone formation of the mxl

Avascular necrosis
Occurs where there is poor blood supply

Volkmann's ischemic contracure
Result after a compartment syndrome or injury to an artery causes ischemic contracture of the affected mxl

Disuse osteoporosis
May occur with prolonged immobilization 
This is reversible once its recovered

SXS

During immobilization 
Pain on site or surrounding
Tissue repair and callus formation at fx site
Reduced circulation, edema, disuse atrophy, connective tissue contracture
High tone, TrP

Nerve compression infxn, plaster sores, porr cast fit, compartment syndrome may occur temporarily 

Observation

With cast
Heat, swelling under the cast
Pain
mxl guarding
High tone and TrP

Without cast
Mxl atrophy
Maybe cold to touch d/t tissue ischemia
High tone and TrP

Testing

AROM, PROM

 Contraindicated
ROM >> OP
Hot hydrotherapy
Deep NM tech
If metal is implanted, NO Hydrotherapy

Treatment goals

With cast
Elevate the cast
Hydrotherapy: Cold
Reduce inflammation, pain, edema, promote circulation
Maintain ROM
Improve tissue health
PROM

 Without cast
Increase ROM
Strengthen disuse atrophy mxl

Self care

With cast
Hydrotherapy: Cold
Remedial exercise

 Without cast
Hydrotherapy: hot/cold contrast
AROM
Stretch, Strength mxl
Self massage for adhesion

Treatment frequency and outcome

1-2 tx/week (30mins/tx) till cast is removed
1 tx/qeek (60mins/tx) for 4 weeks

 Upper limbs relatively heal faster than lower limbs
Stress fx will take 6-10 weeks to completely heal









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