PHYSICAL
THERAPY AND
FRACTURES
Dr. Abdul Rashad
Senior Lecture UCPT, UMDC
United College of Physical Therapy
INTRODUCTION
• Physical Therapy for fractures can be divided into
management during immobilization and then after
removal of fixation. The physical therapist must be
careful to avoid anything that might delay repair or
lead to non-union. Thus it is essential that the
principles of fractures are understood and care should
be taken for any particular precautions and
complications.
Physical therapy during immobilization
• The aims during this period are:
• Reduce edema: It is very important to do this as early
as possible to prevent adhesion formation, and to
decrease pain.
• Assist the maintenance of the circulation to the area.
• Maintain muscle function by active or static muscle contractions
• Maintain joint ROM
• Maintain function as allowed by the fracture and the fixation.
• Teach the patient to use crutches, sticks, frames.
• Assessment of the patient is essential in order to decide on
the treatment required. It is not always necessary to treat a
patient throughout this stage provided that the patient can be
taught to do his own exercises. The patient must understand
what is required and be motivated to carry it out. The
physical therapist is responsible for monitoring the patient
through this stage. If it is necessary to continue treatment this
may be in the ward for an inpatient but outpatients may
either be treated in a physiotherapy department or at home.
Good treatment at this stage may prevent some of the
problems that can occur when the fixation is removed.
PATIENT PROBLEMS AND PHYSICAL THERAPY TECHNIQUES
• Swelling should be reduced by elevating the limb and
by active or static contractions of muscles thus
minimizing the formation of adhesions and
consequent stiff joints.
•Active exercises by static or isotonic muscle
activity will help to maintain a good blood
supply to the soft tissues and aid in the reduction
of swelling and prevent the formation of
adhesions.
2) PHYSICAL THERAPY AFTER THE REMOVAL OF FIXATION
•Assessment of the patient should be carried out to formulate a
plan of treatment.
•Factors to be considered during evaluation:
1. Although certain clinical features can be expected after a
particular fracture they will appear in different degrees in each
patient and in some cases may not be present.
2. Every patient presents different problems apart from the injury
and these may relate to age, family, work, leisure and the
psychological reactions of the individual. These factors must be
taken into account in planning a program of treatment and
evaluating progress.
•Aims of treatment:
1.To reduce any swelling.
2.To regain full range of joint movement.
3.To regain full muscle power.
4.To re-educate full function.
1)Swelling
•Swelling should not be a great problem if exercises and
general activities have been carried out during the immobilization
period. It may be a problem in the lower limb if the muscles are
very weak and there is a loss of joint range as both factors will
prevent an adequate pumping action on the veins. Any edema
must be reduced as quickly as possible as this will hinder active
movement and lead to the formation of adhesions thus extending
the rehabilitation period.
RANGE OF JOINT MOVEMENT
•Before attempting to regain any decreased
range of movement the reason for the loss of
range should be determined. It could be due to
pain, edema, adhesions or weak muscles. If there
has been disruption of joint surfaces this may
prevent a return to full range.
MUSCLE POWER
• The building of muscle power will depend on gaining
maximal activity of the muscles and using them in all
actions as prime mover, antagonist, fixator and
associated movements with other muscle groups.
FULL FUNCTION
• In the majority of cases it should be possible to regain full function
but if not it is important to gain the optimum function, and the extent
of this will depend on the complications preventing full recovery.
Planning must also take into account the needs of the patient in
relation to home, work and leisure.
• In preparing a patient to return to work it is important to understand
that the patient may have to work all day and know what type of
work is involved-heavy laboring, industrial work on a production
bench requiring repetitive movements of the hand or foot or both, or
office work which can require a variety of different activities.
• Similarly home and leisure activities must be considered so that the
patient is fully rehabilitated.
PHYSICAL THERAPY TECHNIQUES
• These aregiven and must be carefully selected following
the assessment of the patient.
• The physical therapist must evaluate each treatment and
change the techniques as required.
• Treatment should be gradually intensive, particularly in the
final stages of rehabilitation, but always within the capability
of the patient.
• Select the appropriate techniques and decide how they should
be carried out. For example, with movement techniques judge
carefully how many times each exercise should be performed
and whether assistance or resistance is required.
MYOSITIS OSSIFICANS
MANAGEMENT
• Contraindications: Massage, passive movement,
passive stretching, and resistive exercise are
contraindicated if the brachialis muscle is implicated
after trauma.
• Conservative treatment: The elbow should be kept
at rest in a splint, which should be removed only
periodically during the day for active, pain-free
ROM. Rest should continue until the bony mass
matures and then resorbs.
VOLKMANN’S ISCHEMIC CONTRACTURE
CLINICAL PICTURE
• Deformity: Flexion of the wrist and interphalangeal
joints, with extension of the metacarpo-phalangeal joints
• Atrophy: The forearm muscles become atrophied.
• Ischemic neuritis: Sensory loss along the distribution of
the median nerve.
• Trophic changes in the fingers are often present.
• Contracture: The flexors of the fingers are short. When
the wrist is flexed, the fingers can be passively extended;
when the wrist is extended, the fingers become flexed
and cannot be passively extended.
PREVENTION
Early reduction of the fractures around the
elbow to relieve any pressure of the brachial
artery. Position of fixation of supracondylar
fracture should be in full elbow extension with
the forearm supinated.
Avoid tight bandage.
Early treatment at the onset of ischaemia.
TREATMENT
Non operative treatment: Stretching of the
contracture on a splint.
Operative treatment followed by physical
exercises to regain the ROM and muscle power
as much as possible.
Shoulder-Hand syndrome
• Definition: It is a painful shoulder with limited
movement and symptoms of swelling, pain, stiffness,
sweating, and color changes of the hand.
CAUSES:
Post-hemiplegia.
Post-traumatic
CLINICAL PICTURE
• Restriction of wrist movement and it is
maintained in a flexed position.
• Pain and swelling in the hand. Trophic skin
changes.
• Vasomotor changes.
• Pain and limited ROM of the shoulder.
PHYSICAL THERAPY MANAGEMENT:
Paraffin baths to the hands.
Increase limited ROM of the shoulder and hand
by using:
Joint mobilization technique.
Muscle elongation and stretching.
Soft-tissue stretching.
•3- Increase the activity of the upper limb through:
(a)Isotonic exercises
(b)Functional activities.
Elevate and warp the extremity if there is edema.
Educate
program the patient theactivity.
of increased importance of the
