PENANGANAN FRAKTUR (Time Table Hoppenfeld) - 1

1
PENANGANAN FRAKTUR KLAVIKULA
0 1 Week 2 Weeks 4 6 Weeks 6 8 Weeks 6 12 Weeks

Bone Stability None None to minimal With bridging callus, the With bridging callus, Stable
Heali fracture is usually the fracture is usually
ng stable; confirm w/ stable; confirm w/
physical examination physical examination
Stage Inflammatory phase Beginning of reparative Reparative phase Reparative phase Remodeling phase
phase
X-Ray Callus (-) None to early callus; Bridging callus is visible. Bridging callus is more Bridging callus is very
fracture line is visible Fracture line is less apparent. Fracture line visible. Fracture line
distinct is less distinct becomes even less
distinct
Presc Precauti Shoulder is held in add & Shoulder is held in add & Limit abduction None. Avoid contact None
riptio ons int rotation. Elbow is int rotation. Elbow is held sports
n maintained at 90 of at 90 of flexion
flexion
ROM No ROM to the shoulder Gentle pendulum ex to At the end of 6 weeks, Active to active- Active, active-assistive
the shoulder in the sling gentle active ROM to assistive ROM in all ROM shoulder
as pain permits the shoulder is allowed. planes
Abd is limited to 80.
Muscle No strengthening ex to No strengthening ex to Pendulum ex are Resistive ex to the Isometric & isotonic ex
Strength the shoulder the shoulder. Start gentle prescribed to the shoulder girdle muscles are prescribed to the
isometric ex to the shouler w/ gravity shoulder girdle
deltoid elimination. Start muscles. Resistive ex
isometric ex to the are prescribed
rotator cuff & deltoids
Function The uninvolved extremity The uninvolved extremity The patient uses the The patient uses the The involved extremity
al Act. is used in self-care & is used in self-care & affected extremity for involved extremity for is used in self-care &
personal hygiene personal hygiene some self-care & self-care, personal functional activities
personal hygiene hygiene, stabilization &
light activity
Weight None None None Gradual WB is allowed FWB
Bearing
1
Penanganan Fraktur (dikutip dari Treatment & Rehabilitation of Fractures; Hoppenfeld) by Fanny Christina; Printed by Indriana
2
PENANGANAN FRAKTUR HUMERUS PROKSIMAL
0 1 Week 2 - 4 Weeks 4 6 Weeks 6 8 Weeks 8 12 Weeks

Bone Stability None None to minimal With bridging callus, the With bridging callus, the Stable
Heali fracture is usually stable; fracture is usually
ng confirm w/ physical stable; confirm w/
examination physical examination
phase
X-Ray Callus (-). The No callus; fracture line is Bridging callus is visible. With Bridging callus is visible. Abundant callus;
fracture line is visible still visible increased rigidity of the With increased rigidity, fracture line begins
fixation, less bridging callus is less bridging callus is to disappear. With
noted, & healing w/ endosteal noted, & healing w/ the time, there will
callus predominates. Expect endosteal callus be reconstitution of
less callus in end-of-bone predominates. The the medullary canal
fractures than in midshaft fractures line is less
fractures distinct
Presc Precauti Avoid shoulder Avoid int/ext rotation of Do not apply force in Avoid forced ROM None
riptio ons motion the shoulder attempting to regain the full
n ROM
ROM None at the shoulder Patients treated Shoulder limited range Active, active-assistive Active & passive
& elbow. Gentle conservatively with a Flexion/abd up to 100-110 & passive ROM to the ROM to the shoulder
pendulum ex w/ sling can continue w/ Int/ext rotation limited shoulder & elbow in all & elbow in all
elimination of gravity pendulum ex. Active to Pendulum ex against gravity planes, to tolerance planes
are allowed for gentle passive-assistive Elbow full ROM in flexion,
nondisplaced ex to the shoulder. extension, supination &
fractures & Patient treated surgically pronation
hemiarthroplasty should start passive- Surgically treated patients
assistive ROM in supine may continue w/ passive-
position. No active ROM assistive ROM ex
to the shoulder
Muscle No strengthening ex Isometric shoulder ex in Shoulder avoid ex to the Continue isometric ex to Resistive ex to the
Strength to the elbow or patients treated w/ sling deltoid if it is incised during the shoulder. shoulder w/ gradual
shoulder are only. No strengthening ex surgery Continue w/ isometric & increases in
permitted for patients treated w/ Elbow isometric & isotonic isotonic ex to the elbow. weights. Isokinetic
surgical intervention ex Start progressive ex using
resistive ex for patients appropriate
2
treated w/ a sling equipment to
improve strength &
endurance
Function One-handed activities Patient continues w/ one- Involved extremity used for The involved extremity Patient should be
al Act. w/ the uninvolved handed activities & dressing & grooming as is used for self-care & able to use the
extremity. The patient needs assistance in tolerated. Patient still needs feeding. The patient affected extremity
needs assistance in dressing, grooming & assistance in house cleaning may still need to use w/o significant
dressing, grooming & preparing meals. & preparing meals the uninvolved limitations in ADL &
preparing meals extremity for some self- self-care
care activities
Weight None on affected None on affected None o affected extremity WB as tolerated FWB
Bearing extremity extremity
3
PENANGANAN FRAKTUR DIAPHYSIS ATAU MIDSHAFT HUMERUS
0 1 Week 2 Weeks 4 6 Weeks 8 12 Weeks

Bone Stability None None to minimal Bridging callus & moderate Stable callus
Healing stability
Stage Inflammatory phase Beginning of reparative phase Reparative phase Remodeling phase
X-Ray Callus (-) None to very early callus Bridging callus is visible Abundant callus, fracture line
begins disappear,
reconstitution of medullary
canal.
Non union is clearly evident
Prescrip Precauti No Lifting w/ the affected No Lifting w/ the affected No heavy lifting w/ the No contact sports
tion ons extremity extremity affected extremity
ROM Brace / Splint : No ROM to the Active & active-assistive ROM to Active & active-assistive Active, active-assistive &
shoulder & elbow the shoulder & elbow. W/ splint ROM to the shoulder & passive ROM tp the shoulder
ORIF / external fixator : gentle or brace, no abd shoulder > 60 elbow & elbow
active & active-assistive ROM
to the shoulder & elbow if
fixation is stable. Pendulum ex.
w/ gravity (-) to the shoulder
Muscle No strengthening exc. to the Gentle pendulum exercise to the Isometric & isotonic exc. To Progressive resistive exc. to
Strengt elbow or shoulder shoulder. No strengthening the forearm muscles. the shoulder & elbow
h exercise to shoulder & elbow After 6 weeks, isometric exc.
To biceps & triceps
Function Uninvolved extremity may be ADL w/ uninvolved extremity. Involved extremity may be Involved extremity may be
al used for self-care & ADL In ORIF & external fixation, used for basic self-care & used in ADL. Light lifting is
Activitie involved extremity used for personal hygiene allowed w/ the affected
s feeding, light grooming, writing extremity
3
Weight NWB on affected extremity NWB on affected extremity. Early WB is allowed w/ int. FWB is allowed
Bearing Limited WB w/ rodding fixation
4
PENANGANAN FRAKTUR HUMERUS DISTAL

Bone Stability No bony stability. Some None to minimal Once calus is observed Stable
Healing stability may be afforded ba an bridging the fracture site,
intact periosteum & ligaments the fracture is usually
stable. This should be
confirmed by physical
examination. The strength
of this callus is significantly
lower than of normal bone,
especially w/ torsional load
Stage Inflammatory phase Beginning of reparative phase Reparative phase Remodeling phase
X-Ray Callus (-) None to early callus Bridging callus is visible. W/ Callus is present but less
increased rigidity, less than in midshaft. The
bridging callus is noted & fracture line begins to
healing w/ endosteal callus disappear. Reconstitution of
predominates medullary canal occurs w/
time.
Prescrip Precauti No int or ext rotation of the No int or ext rotation of the Avoid rotational stresses Avoid heavy lifting or
tion ons shoulder. shoulder. across the elbow pushing
No passive ROM to the elbow No passive ROM to the elbow
ROM Gentle active elbow flexion & Gentle active flexion & extension Active / active-assistive Active & passive ROM to the
extension allowed for stable exc. to the elbow for fractures flexion & extension to the elbow
fractures treated w/ ORIF. only when treated w/ ORIF. elbow
No ROM to the elbow if treated Gentle assistive supervised active
by other methods flexion & extension for
nondisplaced stable fractures
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Muscle No strengthening exc. to the No strengthening exc. to the No strengthening exc. to Progressive resistive exc. to
Strengt elbow elbow the elbow the elbow musculature
h
Function The uninvolved extremity is The uninvolved extremity is used The uninvolved extremity is The involved extremity used
al used for self-care & ADL for self-care & ADL used for self-care & ADL for self-care & personal
Activitie hygiene
s
Weight NWB on affected extremity NWB on affected extremity NWB on affected extremity FWB by 12 weeks
Bearing
5
PENANGANAN FRAKTUR OLEKRANON

Bone Stability None None to minimal W/ bridging callus, the Stable Stable
Healing fracture line is usually
stable
phase
X-Ray Callus (-) None to early callus. Bridging callus is visible. Bridging callus is more More callus is seen
Fracture line is visible Fracture line is less apparent, especially w/ 7 fracture line
distinct. Endosteal callus less-rigid fixation. becomes even less
formation will Fracture line is less distinct
predominate distinct. There is less
callus formation if the
fracture site is at the end
of the ulna than in a
midshaft fracture..
Prescrip Precauti Avoid premature elbow Cast or splint : no Active to active-assitive None None
tion ons motion extension to the elbow ROM to the elbow & wrist
< 90
ROM No ROM to the elbow or No ROM to the elbow or Encourage active ROM to Full active to active- Full active & active-
wrist in a cast or splint. wrist in a cast or splint. the elbow in flexion & assitive ROM in all planes assisted ROM in all
Gentle active elbow Active elbow flexion & extension to the elbow & wrist planes to the elbow
5
flexion & active ROM to active ROM to the wrist & wrist
the wrist if treated if treated surgically
surgically
Muscle No strengthening exc. No strengthening exc. to Isometric exc. to the Resistive exc. to the Resistive exc. to the
Strengt to the elbow. the elbow in extension. elbow & wrist in flexion & elbow & wrist elbow & wrist
h Three or 4 days after Isometric exc. to the extension
fracture, isometric exc. elbow in flexion in a
to the wrist within the cast.
cast Isometric exc. to the
wrist
Function One-handed activities. The patient uses the The patient uses the The patient uses the The patient uses the
al The patient uses the uninvolved extremity for affected extremity for affected extremity for affected extremity
Activitie uninvolved extremity personal hygiene & self- stability & light self-care personal hygiene & self- for personal hygiene
s for personal hygiene & care care & self-care
self-care
Weight None None NWB Gradual WB is allowed FWB is allowed
Bearing
6
PENANGANAN FRAKTUR RADIAL HEAD

Bone Stability None None to minimal W/ bridging callus, the Stable
Healing fracture line is usually
stable; confirm w/ physical
examination
Stage Inflammatory phase Beginning of reparative Reparative phase Remodeling phase
phase
X-Ray Callus (-) Callus (-) Bridging callus is visible. Visible bridging callus
W/ increased rigidity, less in nonoperative
bridging callus is noted & patients. There is less
healing w/ endosteal callus callus with int fixation
predominates. The amount
of callus formation is less
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at the ends of the long
bones, compared to
midshaft fractures
Prescrip Precauti No passive ROM to the No passive ROM to the Avoid valgus stresses to No pushing or lifting
tion ons elbow elbow the elbow to avoid stress heavy objects
on the radial head
ROM Gentle, active ROM to Active ROM to the elbow Active, active-assistive & Active & passive ROM
the elbow in flexion & passive ROM to the elbow to the elbow
pronation for nonoperative cases.
Active & active-assistive
ROM for patients w/ int.
fixation
Muscle No strengthening exc. to No strengthening exc. to Isometric exc. to the Progressive resistive
Strengt the elbow. the elbow. Start isometric biceps, triceps & deltoid exc. are given to the
h exc. to the deltoid, elbow flexor, extensors,
biceps & triceps supinators & pronators
Function The uninvolved The uninvolved extremity The uninvolved extremity The affected extremity
al extremity is used for is used for self-care is used in self-care. The is used in self-care
Activitie ADL involved extremity is used
s to assist in gentle activities
Weight None None PWB for patients w/ WB allowed for self-
Bearing nonoperative fixation. NWB care & light-duty
for patients w/ int fixation activities
7
PENANGANAN FRAKTUR FOREARM

Bone Stability None None to minimal Once callus is observed Stable
Healing bridging the fracture site, the
fracture is usually stable. This
should be confirmed w/
physical examination. The
strength of this callus is
significantly lower than that of
normal bone.
Stage Inflammatory phase Beginning of reparative Reparative phase Woven bone is replaced by lamellar
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phase bone. The process of remodeling
takes months to years. Patients
whose treatment is w/ rigid fixation
have direct bridging osteomes.
X-Ray Callus (-) None to early callus Bridging callus is visible in Abundant callus is present if cast
patient w/ a cast. Patient who treatment was used. The fracture
have had anatomic rigid int line begins disappear &
fixation show little or no reconstitution of the medullary
callus, because primary bone canal occurs w/ time. Patient who
healing predominates. The have had anatomic rigid int fixation
fracture line becomes less show little or no callus; rather, the
visible. fracture line disappear as primary
bone healing progresses. The
amount of callus is inversely
proportional to the stability.
Prescrip Precauti No passive ROM No passive ROM No passive ROM to the No heavy lifting or sports activities
tion ons forearm
ROM If there is adequate Gentle active ROM to the Active to active-assistive ROM Full active & passive ROM to the
fixation & the forearm is elbow & wrist if there is to the elbow & wrist, including elbow & wrist. Stress supination &
not in a cast, gentle active adequate fixation & the supination & pronation if the pronation of the forearm
ROM exc. are prescribed forearm is not in a cast patient is out of cast.
to the elbow & wrist,
including supination &
pronation exc.
Muscle Isometric exc. to the No strengthening exc. to If fixation is adequate at end Progressive resistive exc. are
Strengt deltoid, biceps & triceps if the forearm if treated w/ of 6 weeks, start gentle prescribed for the forearm muscles.
h the fracture is rigidly cast only. Isometric exc. isokinetic exc. to the forearm Use free weights of 5 lb & more
fixed. No strengthening to the deltoid, biceps & muscles w/ < 5 lb of
exc. to the forearm if triceps w/ rigid fixation resistance
treated w/ cast only
Function The uninvolved extremity The uninvolved extremity The involved extremity is used The affected extremity is used for
al is used for self-care is used for self-care for light self-care activities. self-care
Activitie
s
Weight NWB on the affected NWB on the affected NWB on the affected extremity FWB as tolerated
Bearing extremity extremity
8
PENANGANAN FRAKTUR COLLES

Bone Stability None None to minimal W/ bridging callus, the W/ bridging callus, the Satble
8
Healing fracture is usually stable; fracture is usually
confirm w/ physical stable; confirm w/
Stage Inflammatory phase Beginning of Reparative phase Reparative phase Remodeling phase
reparative phase
X-Ray Callus (-); fracture None to early callus; Bridging callus is visible. Bridging callus is Callus is seen. The
line is visible fracture line is visible W/ increased rigidity, visible. W/ increased fracture line begins to
less bridging callus is rigidity, less bridging disappear; w/ time, the
noted, & healing w/ callus is noted, & contour of the bone is
endosteal callus healing w/ endosteal being restored.
predominates. The callus predominates. Metaphyseal areas do
fracture line is less The fracture line is not produce as much
distinct. less distinct. callus as diaphyseal
regions
Prescrip Precauti No supination & No supination & No passive ROM to the None, unless None
tion ons pronation pronation if treated w/ forearm pseudoarthrosis or
No ROM to wrist cast & ORIF nonunion is suspected
No passive ROM
ROM Full active ROM of Full ROM of MCP & IP Full active ROM of wrist, Full ROM of all joints of Full ROM, active &
digits of MCP joint. joint. MCP & IP joints. upper extremity. passive in all planes to
Full opposition of Attempt gentle active Supination & pronation Stress supination & the wrist & digits.
thumb ROM of wrist if treated encouraged. Active ulnar ulnar deviation. Stress supination &
by ORIF & fixation is & radial deviation. Active assistive to ulnar deviation
rigid. passive ROM
attempted or initiated.
Muscle Attempt isometric Isometric exc. given to Gentle resistive exc. Gentle resistive exc. to Progressive resistive
Strengt exc. to the intrinsic the intrinsic muscles given to the digits of the the digits & wrist. exc. to the wrist &
h muscles of the hand of the hand & wrist hand. Improve power grip digits & to all the
flexor & extensor. Improve power grip groups of muscles
Isometric exc. to wrist
flexors, extensors &
radial and ulnar
deviators. Gentle
resistive exc. given to
the wrist if treated by
ORIF
Function Use the uninvolved Uninvolved extremity The involved extremity The affected extremity The patient may use
al extremity for self- is used for self-care & may be used as a is used for self-care & the involved extremity
Activitie care & ADL ADL stabilizer in two-handed ADL in self-care & ADL
s activities. The patient
may attempt self-care w/
involved extremity.
Weight NWB on the affected NWB on the affected Avoid WB until the end of WB as tolerated, FWB as tolerated on
Bearing extremity extremity 6 weeks because the fracture the involved extremity
is stable
9
PENANGANAN FRAKTUR SCAPHOID (NAVICULAR)

Bone Stability No bony stability, None to minimal Bridging callus indicates Stable Stable
Healing although ligamentous stability
stability may be
present
Stage Inflammatory phase Beginning of reparative Reparative phase Remodeling phase Remodeling phase
phase
X-Ray Callus (-); fracture line Callus (-). Resorption at Callus is not seen Fracture line begins Fracture line begins to
is visible fracture site may be because there is no to disappear w/ disappear. There is
seen periosteum. This is a reconstitution of reconstitution of the
membranous bone. trabecular bone trabecular bone
Trabecular bone may be pattern pattern
visible
Prescrip Precauti Avoid supination & Avoid supination & Avoid passive ROM to the Avoid heavy lifting None if fracture is
tion ons pronation of the pronation at the elbow thumb & wrist healed
elbow
ROM Thumb, Wrist none Thumb, Wrist none Thumb If short arm cast Cast is removed after Active-resistive,
(immobilized) (immobilized) is removed (ORIF), gentle 12 weeks. Gentle passive ROM of wrist &
Elbow none if Elbow none if active ROM to the wrist & active ROM to wrist & thumb.
immobilized in a long immobilized in a long thumb in flexion, digits & MCP & IP
arm cast. If in a short arm cast. If in a short extension & thumb joints of thumb.
arm cast, gentle arm cast, gentle active opposition. Hydrotherapy W/ ORiF, active,
active elbow flexion & elbow flexion & to improve the ROM active-assistive &
extension extension Elbow Gentle active passive ROM to the
Digits Gentle active Digits Active & ROM in flexion extension wrist & thumb to
ROM passive ROM (long arm cast) & short maximize full ROM
Shoulder gentle Shoulder Active & arm cast applied. No
active & active- active-assistive ROM supination/pronation
assistive ROM Shoulder, Digits Active
& passive ROM
Muscle Thumb, Wrist, Elbow Thumb, Wrist, Elbow Elbow Isotonic exc. in Wrist After 12 Active-resistive to
Strengt no strengthening exc. no strengthening exc. flexion weeks, active progressive-resistive
h Shoulder Isometric Shoulder Isometric Shoulder - Extension, resistive exc. to long exc. to the wrist &
exc. to deltoid, biceps exc. to deltoid, biceps shoulder add/abd flexors & extensors of thumb
& triceps & triceps thumb & wrist
Elbow Resistive exc.
to elbow flexors,
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extensors, supinators
& pronators
Function One-handed The patient uses the The patient needs Patient uses the Involved extremity is
al activities. Uninvolved uninvolved extremity assistance in self-care & involved extremity for used for all self-care
Activitie extremity used in self- for personal hygiene & dressing & uses the stabilization purposes activities
s care & dressing self-care uninvolved extremity for & certain self-care
self-care & personal activities
hygiene
Weight NWB on the affected NWB on the affected NWB on the affected WB is allowed after FWB is allowed
Bearing extremity extremity extremity 12 weeks
10
PENANGANAN FRAKTUR METACARPAL

Bone Stability None None to minimal W/ bridging callus, the W/ bridging callus, the Stable
Healing fracture is usually stable; fracture is usually
confirm w/ physical stable; confirm w/
reparative phase
X-Ray Callus (-) Callus (-) Bridging callus is visible. Bridging callus is Abundant callus is
W/ increased rigidity, visible. W/ increased seen & the fracture
less bridging callus is rigidity, less bridging line begins to
noted & healing w/ callus is noted & disappear; w/ time,
endosteal callus healing w/ endosteal there will be
predominates. Fracture callus predominates. reconstitution of the
line is less distinct Fracture line is less medullary canal.
distinct Metaphyseal areas do
not produce as much
callus as diaphyseal
regions
Prescrip Precauti No passive ROM No passive ROM to No passive ROM to the None None
tion ons the affected digit affected digit
ROM Active ROM to non- 1. If rigid 1. Full active ROM Active, active-assistive Full active & passive
splinted digits fixation is achieved, to all digits & wrist & passive ROM to all ROM to all digits
active ROM to the 2. Active pronation digits
affected digit & supination of wrist &
2. Active, active- ulnar & radial deviation
assistive & passive of the wrist
ROM to non-splinted
10
digits
Muscle Isometric exc. Isometric exc. to the 1. Gentle ball- Active-resistive exc. to Progressive resistive
Strengt prescribed within the intrinsic muscles of squeezing & Silly Putty all digits & wrist exc. to the all digits w/
h cast of the non- non-splinted digits exc. increasing weights
splinted fingers 2. Gentle add & abd
resistive exc. of the
digits
Function Uninvolved extremity Uninvolved extremity Bimanual activities are The patient uses The affected extremity
al used in self-care & used in self-care & encouraged at 6 weeks affected extremity for used for self-care
Activitie personal hygiene personal hygiene self-care & personal
s hygiene
Weight None None None FWB as tolerated FWB
Bearing
11
PENANGANAN FRAKTUR PHALANG

Bone Stability None None to minimal W/ bridging callus, the W/ bridging callus, the Stable
Healing fracture is usually fracture is usually
stable; confirm w/ stable. However, the
physical examination strength of this callus,
especially w/ torsional
load, is significantly
lower than that of
normal lamellar bone.
Confirm w/ physical
examination
reparative phase
X-Ray Callus (-); fracture None to early callus; Bridging callus is visible. Bridging callus is visible. Abundant callus is
line is visible fracture line is visible W/ increased rigidity, W/ increased rigidity, seen & the fracture
less bridging callus is less bridging callus is line begins to
noted & healing w/ noted & healing w/ disappear; there is
endosteal callus endosteal callus reconstitution of the
predominates. Fracture predominates. Fracture medullary canal.
line is less distinct line is less distinct Metaphyseal areas do
not produce as much
callus as diaphyseal
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regions
Prescrip Precauti No ROM to the digit No ROM to the No passive ROM to the Night splint is used if None
tion ons if the fracture is splinted joint affected joint necessary
unstable
ROM Active ROM to the Active ROM to all non- Full active & active- Active, active-assistive Full active & passive
unaffected digits & splinted joints & digits assistive ROM to all & passive ROM to all ROM to all digits &
to the fractured digit digits digits wrist.
if the fracture is
stable
Muscle Isometric exc. to the Isometric Isometric & isotonic exc. Gentle resistive exc. to Progressive resistive
Strengt intrinsic muscles of strengthening exc. to to the flexors, all digits exc. to the digits &
h the non-splinted the intrinsic muscles extensors, abd & add of wrist
fingers the digit
Function The uninvolved The uninvolved Bimanual activities The involved extremity The involved extremity
al extremity used for extremity used for using the involved is used for self-care is used in all activities
Activitie self-care & personal self-care extremity are to tolerance
s hygiene encouraged for self-care
Weight None None WB as tolerated by the FWB FWB
Bearing patient
12
PENANGANAN FRAKTUR COLLUM / NECK FEMUR

Bone Stabilit No stability is present from Only minimal stability. Moderate stability from Moderate stability Significant stability is
Heali y bone healing. Impacted femoral neck bone healing is present as from bone healing is now present from
ng Impacted femoral neck fracture : partial bony endosteal callus bridges present as endosteal bone healing as
fracture : partial bony stability the fracture; correlate w/ callus bridges the endosteal callus
stability Treated w/ screws, except physical examination. fracture; correlate w/ bridges the fracture;
Treated w/ screw, except severe osteopenia : Mechanical stability from physical examination. correlate w/ physical
severe osteopenia : immediate mechanical hardware or Mechanical stability examination.
immediate mechanical stability endoprosthesis is from hardware or Mechanical stability
stability Treated w/ unchanged endoprosthesis is from hardware or
Treated w/ hemiarthroplasty : full unchanged endoprosthesis is
hemiarthroplasty : full mechanical stability unchanged
mechanical stability
Stage Inflammatory phase Beginning of reparative Reparative phase Late reparative, early Remodelling phase
phase remodeling phase
X-Ray Callus (-), fracture line is No callus is visible No external callus is No external callus is No external callus is
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clearly visible. No (healing is visible because healing is visible because visible because
periosteum, all healing is endosteal/intenal) endosteal (internal) & healing is endosteal healing is endosteal
endosteal Fracture line is visible composed of cartilage & (internal) & (internal) &
fibrous tissue; this composed of composed of
gradually becomes visible cartilage & fibrous cartilage & fibrous
as it undergoes tissue; this gradually tissue; this gradually
endochondral ossification becomes visible as it becomes visible as it
undergoes undergoes
endochondral endochondral
ossification ossification. Fracture
line is obliterated
Presc Precau- Avoid passive ROM. Avoid passive ROM on No passive ROM on Avoid excessive add Avoid excessive add if
riptio tions Patient treated w/ fractures that have been fractures that have been & int rotation if use use endoprosthesis
n endoprotheses avoid int. reduced. reduced. endoprosthesis
rotation & add past midline Treated w/ Treated w/
endoprotheses : avoid int. hemiarthroplasty : avoid
rotation & add past int rotation & add past
midline midline
ROM Active ROM hip & knee Active, active-assistive Active, active-assistive Active, active-assitive Full active & passive
ROM to hip & knee ROM to hip & knee & passive ROM to hip ROM to hip & knee
& knee
Muscle Isometric gluteal & Isometric gluteal & Isometric & isotonic exc. Isotonic & isokinetic Isokinetic & isotonic
Strengt quadriceps exc. quadriceps exc. to hip & knee exc. to hip & knee. exc. & progressive
h Isotonic exc. to ankle Progressive resistive resistive exc.
exc. instituted
Functio Stand-pivot transfers & Stand-pivot transfers & Stand-pivot transfers & WB transfers & Independent in
nal Act. ambulation w/ assistive ambulation w/ assistive ambulation w/ assistive ambulation w/ transfers &
devices; raised toilet seat devices devices assistive devices ambulation w/o
& chair assistive devices
Weight Stable impacted fracture Stable impacted fracture Stable impacted fracture FWB to WB as FWB
Bearin or endoprotheses : WB as or endoprotheses : WB as or endoprotheses : WB as tolerated
g tolerated tolerated tolerated
Unstable fracture that Unstable fracture that Unstable fracture that
require reduction : NWB require reduction : NWB require reduction : NWB
13
PENANGANAN FRAKTUR INTERTROCHANTER FEMUR

Bone Stability None None to minimal With a bridging callus, the Stable
Heali fracture is usually stable;
ng confirm w/ physical
examination
Stage Inflammatory phase Beginning of reparative Reparative phase Early remodeling
phase phase
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X-Ray Callus (-), fracture line is None to very early callus; Bridging callus is beginning to Abundant callus
visible. fracture line is visible. Bone be visible. Endosteal callus has formed &
in the metaphyseal region may predominate in the fracture line begins
has very thin periosteum & metaphyseal region & the to disappear. The
does not form an abundant fracture line should become medullary canal &
external callus less visible metaphyseal
region begin to be
reconstituted.
Presc Precauti Avoid passive ROM Avoid standing on the Avoid torsion or twisting at None
riptio ons affected leg w/o support. the fracture site
n Avoid passive ROM
ROM Gentle active ROM exc. to Active ROM to hip & knee. Active, active-assistive ROM Continue active,
hip & knee in flexion, Achieved 90 flexion at hip to hip & knee active-assistive
extension, abd & add ROM. Start passive
ROM & stretching
to hip & knee
Muscle Isometric exc. to quadriceps Isometric exc. to glutei, Isometric exc. to glutei, Progessive
Strength & glutei quadriceps & hamstrings quadriceps & hamstrings. resistive exc. to hip
Active-resistive exc. to & knee
quadriceps, glutei &
hamstrings, if motion is well
tolerated
Function Stand-pivot transfers if NWB. Depending on WB, the Depending on WB, stand- The patient uses
al Act. If WB, the affected extremity patient performs stand- pivot transfers or WB as involved extremity
is used during transfers. A pivot transfers or uses the tolerated on the affected w/ WB as tolerated
raised toilet seat is used to affected extremity during extremity during transfers. or FWB during
decrease hip flexion. transfers. Ambulation w/ AD transfers &
For ambulation, use a two- For ambulation, use two- or ambulation.
or three-point gait three-point gait w/ AD Weaning from AD
depending on WB status,
using AD
Weight Stable fractures : WB as Depending on procedure, Unstable fractures : Partial to Full
Bearing tolerated WB as tolerated. NWB to NWB to toe-touch
Unstable fractures : toe- PWB, to toe-touch for Stable fracture : WB as
touch to partial or NWB unstable fractures tolerated
14
PENANGANAN FRAKTUR SUBTROCHANTER FEMUR
14
Bone Stability None None to minimal Callus is beginning to bridge Stable Stable
Heali fracture fragments in the
ng femoral region (thick
periosteum) & endosteal
healing is bridging the
metaphyseal region (thin
periosteum but rich
intramedullary blood supply).
Unless bone loss or severe
comminution is present, the
fracture is usually stable;
confirm w/ physical
examination
Stage Inflammatory phase Beginning of reparative Reparative phase Early remodeling Remodeling phase
phase phase
X-Ray Callus (-), fracture None to very early callus Bridging callus is beginning to Abundant callus in Abundant callus is
line is clearly visible. in the region below the be visible. W/ increased fracture w/ intact present & fracture line
lesser trochanter. Callus rigidity of fixation, less periosteum. Fracture begins to disappear
(-) in the bridging callus is noted & line begins disappear
intertrochanteric region healing w/ endosteal callus
where periosteum is thin predominates. Fracture line is
& healing is less visible in both the shaft &
predominately endosteal. metaphyseal regions
Fracture line is visible
Presc Precau- No add & abd to hip. Avoid torsional forces on Avoid torsional forces on None None
riptio tions No isometric exc. to fracture. Avoid excessive fracture site.
n quads & hamstrings abd or add
ROM Active ROM to hip & Active, active-assistive to Active, active-assistive, Full ROM in all planes Full ROM in all planes to
knee in flexion & gentle passive ROM to passive ROM to hip in flexion to hip & knee hip & knee
extension hip in flexion & extension & extension. Active ROM to hip
in abd & add
Muscle Isometric exc. to Isometric exc. to glutei, Isometric exc. to glutei, Gradual resistive exc. Prgressive resistive exc.
Strengt glutei quadriceps & hamstrings quadriceps & hamstrings. to hip & knee to hip & knee
h
Functio WB as tolerated or Toe-touch WB or WB as Toe-touch WB or WB as WB as tolerated or FWB during transfer &
nal Act. toe-touch WB during tolerated during tolerated during transfers & FWB during transfers ambulation
transfers w/ AD & 3- transfers & 3-point gait; ambulation w/ AD & ambulation w/ AD
point gait w/ AD WB as tolerated or toe-
touch WB w/ AD
Weight Stable fractures Stable fractures treated Stable fractures treated w/ Almost all fractures Almost all fractures
Bearing treated w/ w/ intramedullary nails: intramedullary nails: WB as have sufficient bone have sufficient bone
intramedullary nails: WB as tolerated on tolerated on affected healing & callus to be healing & callus to be
WB as tolerated on affected extremity extremity FWB as tolerated. FWB as tolerated.
affected extremity Unstable fractures or Unstable fractures or those Limited WB should be Limited WB should be
Unstable fractures or those treated by ORIF : treated by ORIF : toe-touch necessary only for necessary only for
those treated by toe-touch WB WB fractures w/ no callus fractures w/ no callus
ORIF : toe-touch WB present that are present that are being
being considered for considered for bone
bone grafting grafting
15
PENANGANAN FRAKTUR SHAFT FEMUR
0 1 Week 2 - 4 Weeks 4 6 Weeks 8 12 Weeks 12 16 Weeks

Bone Stability None None to minimal With bridging callus, the Stable Stable
ng confirm w/ PE
phase phase
X-Ray Callus (-), fracture line is None to very early callus; Bridging callus is beginning Abundant callus in Abundant callus in
clearly visible. fracture line is visible to be visible. W/ increased fractures not rigidly fractures not rigidly
rigidity of fixation, less fixed by plates. fixed by plates.
bridging callus will be Fracture line begins Fracture line begins
noted, & healing w/ to disappear; with to disappear; w/
endosteal callus will time, there will be time, there will be
predominate. The amount reconstitution of the reconstitution of the
of callus formation is medullary canal, medullary canal,
greater for diaphyseal than except w/ an except w/ an
metaphyseal fractures. intramedullary nail intramedullary nail
Fracture line is less visible
Presc Precauti No passive ROM to hip & Avoid rotation on the Avoid rotation on the Avoid torsion loading None
riptio ons knee affected extremity w/ the affected extremity w/ foot of the femur
n No rotation on planted foot planted planted
foot
ROM Active ROM to hip & knee Active, active-assistive Active/passive ROM to hip & Active/passive ROM Active/passive ROM
ROM to hip & knee, knee to hip & knee to hip & knee
passive ROM closer to 4
weeks
Muscle Isometric exc. to quads Isometric ex. to quads & Resistive isotonic exc. & Progessive resistive Progressive resistive
Strength & glutei glutei; straight leg raising isometric exc. to quads, exc. to quads, exc. to quads,
hamstrings & glutei hamstrings & glutei hamstrings & glutei.
Isokinetic exc. to
quadriceps &
hamstrings
Function Ambulatory stand-pivot Ambulatory stand-pivot Stand/pivot transfers & Regular transfers. Regular transfers.
15
al Act. transfers & ambulation transfers w/ crutches & ambulation w/ crutches May need crutches May need crutches
w/ crutches ambulation w/ crutches for ambulation for ambulation
Weight Unstable fractures or Unstable fractures or Unstable fractures & those Stable fracture : FWB
Bearing those treated by plating those treated by plating treated w/ plating or FWB or WB as
or external fixator : toe- or external fixator : toe- external fixator : PWB tolerated
touch or NWB touch or NWB Stable fracture : FWB Unstable fracture :
Stable fracture : progress Stable fracture : WB as PWB
to FWB as tolerated tolerated
16
PENANGANAN FRAKTUR SUPRACONDYLAR FEMUR

Bone Stability None None to minimal With bridging callus, the Stable Stable
ng confirm w/ PE
phase phase
X-Ray Callus (-) None to early callus; Bridging callus is beginning Abundant callus in Abundant callus,
fracture line is visible to be visible. W/ increased fractures not rigidly fracture line begins
rigidity of fixation, less fixed by plates. to disappear. W/
bridging callus will be Fracture line begins time, there will be
noted, & healing w/ to disappear. W/ resorption of the
endosteal callus will time, there will be callus
predominates. The fracture reconstitution of the
line is less visible. A large medullary canal,
amount of callus formation except w/ an
w/ a rigid fixation device intramedullary nail
indicates a lack of rigid
fixation
Presc Precauti Avoid passive ROM Avoid passive ROM No passive ROM No aggressive Do not be aggressive
riptio ons passive ROM in passive ROM
n ROM Active ROM. Attempt full Active ROM 60 - 90 in Knee : Active ROM > 90; Knee : Active, active- Knee : Active &
extension & 60 - 90 of flexion & full extension to active, active-assistive ROM assistive ROM; passive ROM;
flexion to the knee. Avoid the knee. in flexion & extension, if the gentle passive ROM emphasize terminal
16
passive ROM fracture is stable extension to reduce
extension lag
Muscle No strengthening exc. Isometric exc. to Knee : Isometric exc. to Knee : Isometric & Knee : Isometric,
Strength prescribed to the knee quadriceps in supine quadriceps & hamstrings isotonic exc. to isotonic & isokinetic
position & knee in full quadriceps & exc. to quadriceps &
extension hamstrings hamstrings. Gentle
progressive resistive
exc. Muscle strength
4+ or 5
Function NWB stand/pivot NWB ambulation & NWB ambulation & NWB ambulation & PWB w/ crutches,
al Act. transfers & NWB stand/pivot transfers stand/pivot transfers stand/pivot transfers progressing to FWB
ambulation during ambulation &
transfers
Weight None None None None Toe-touch to PWB
Bearing progressing to FWB
17
PENANGANAN FRAKTUR PATELLA

Bone Stability None None to minimal None to minimal Stable
Heali
ng Stage Inflammatory phase Beginning of reparative Reparative phase Remodeling phase
phase
X-Ray Fracture line is visible; no Callus (-); fracture line is No callus; fracture line is Small amount of
callus formation visible less visible. Sesamoid callus noted.
bones produce minimal Fracture line begins
callus to disappear w/ time.
Amount of callus
formed is small,
because this is a
sesamoid bone
Presc Precauti Avoid passive ROM Avoid passive ROM Maintain knee immobilizer if
riptio ons tenderness is present
n ROM Knee : None if in a cast. Knee : None Knee : Active ROM in Knee : Active &
If open reduction & If treated w/ open flexion/extension passive ROM. Patient
17
stable internal fixation is reduction & stable may have extension
achieved, active ROM of internal fixation, active lag secondary to
the knee in a sitting knee flexion w/ no WB quad weakness &
position w/o WB immobilization
Muscle No strengthening exc. Knee : None Knee : Isometric exc. to Knee : Progressive
Strength prescribed to the knee quadriceps & hamstrings. resistive exc. to
At 6 weeks, isotonic exc. to quadriceps &
quadriceps w/ active knee hamstrings w/
extension: 45 to 0 & then weights; isokinetic
from 90 to 0 where 0 is exc. using Cybex
full extension machine; pylometric
closed chain exc.
Function FWB during transfers & FWB during ambulation & FWB during ambulation & FWB during
al Act. ambulation using AD transfers transfers. Remove ambulation 7
immobilizer for level ground transfers w/o AD
walking if fracture is stable
18
PENANGANAN FRAKTUR TIBIAL PLATEAU

Bone Stability None None to minimal W/ bridging callus, the Stable Stable
ng confirm w/ PE
Stage Inflammatory phase Beginning of reparative Reparative phase Early Remodeling Remodeling phase
phase phase
X-Ray No callus None to early callus; Bridging callus is beginning Abundant callus in Fracture line has
fracture line is visible to be visible. W/ increased fracture not rigidly disappeared
rigidity of fixation, less fixed by plates.
bridging callus is noted & Fracture line begins
healing w/ endosteal callus to disappear, w/
predominates. The fracture time the medullary
line is less visible canal will be
reconstituted
Presc Precauti No varus or valgus stress No varus or valgus No varus or valgus stress on No varus or valgus None
18
riptio ons on knee; no passive ROM stress on knee; no knee; no passive ROM stress
n passive ROM
ROM Active & active-assistive Active & active- Active & active-assistive Active, active- Full active & passive
flexion/extension: 40 to assistive ROM to the knee assistive & passive ROM to the knee
60 of flexion allowed flexion/extension up to ROM to the knee
initially, increasingly to 90
90 of flexion after 1
week
Muscle No strengthening exc. to Isometric exc. to the No strengthening exc. to Gentle resistive Progressive resistive
Strength knee quadriceps the knee exc. to the exc. to the knee
quadriceps &
hamstrings
Function NWB stand/pivot NWB stand/pivot NWB transfers & WB transfers & FWB transfers &
al Act. transfers & ambulation transfers & ambulation ambulation w/ crutches ambulation at the ambulation
w/ crutches w/ crutches end of 12 weeks
Weight NWB on the affected NWB on affected NWB on affected extremity Partial to FWB at FWB
Bearing extremity extremity the end of 12
weeks
19
PENANGANAN FRAKTUR SHAFT TIBIA

Bone Stability None None to minimal W/ advancing callus, the Fractures having minimal to no
Heali fracture becomes stable for comminution are increasingly
ng axial loading but must still be stable to completely stable.
protected from torsional Fractures that have significant
loading bone loss or have required bone
grafting for bone loss have
limited stability until the bone
graft begins consolidate & the
19
callus is visible
Stage Inflammatory phase Beginning of reparative Reparative phase Early remodeling phase
phase
X-Ray Callus (-) No callus; fracture line is Early callus may be visible in Bony consolidation is
visible the posterolateral aspect of progressing, & the callus should
the tibia where blood supply be visible at the posterolateral
is best. If the fracture is surface of the tibia in extending
rigidly fixed, little callus is around to the other surfaces. The
seen fracture line should become
cloudy & begin to disappear. If
bone grafting was required,
consolidation of this bone graft
should begin to be seen
Presc Precauti Avoid rotary motion w/ the Avoid rotary movements w/ Avoid rotation of the
riptio ons foot on the floor the foot planted extremity on a fixed foot
n ROM Active ROM ankle & knee if Active ROM ankle & knee if Active ROM to ankle & knee if Active, active-assistive & passive
not in a cast not in a cast not in a cast ROM to knee & ankle
Muscle Isometric ex to quadriceps, Isometric exc. to Isometric & isotonic exc. to Gentle progressive resistive exc.
Strength tibialis anterior & gastroc- quadriceps, tibialis anterior knee & ankle prescribed to quadriceps,
soleus & gastroc-soleus dorsiflexors & plantar flexors.
Function Unstable fractures : stand- Unstable fractures : Unstable fractures : If fracture site is still tender,
al Act. pivot transfers & NWB stand/pivot transfers & stand/pivot transfers & NWB patient may still need AD for
ambulation w/ AD NWB ambulation w/ AD ambulation w/ AD transfers & ambulation
Stable fracture : WB as Stable fracture : WB as Stable fracture : WB as
tolerated to PWB transfers tolerated or PWB w/ AD, tolerated or PWB, to FWB
w/ AD depending on the method transfers & ambulation w/ AD,
of treatment depending on the method of
treatment
Weight Stable fracture patterns Stable fracture patterns Stable fracture patterns As tolerated
Bearing (restoration of cortical (restoration of cortical (restoration of cortical
contact, no comminution, no contact, no comminution, contact, no comminution, no
segmental bone loss) : WB no segmental bone loss) : segmental bone loss) : WB as
as tolerated WB as tolerated tolerated
Unstable fracture (minimal Unstable fracture (minimal Unstable fracture (minimal
cortical contact, cortical contact, cortical contact,
comminution, segmental comminution, bone loss) : comminution, bone loss) :
bone loss) : NWB to toe- NWB to toe-touch NWB to toe-touch
touch
20
PENANGANAN FRAKTUR TIBIAL PLAFOND
20
Bone Stabili None None to minimal Usually stable. Fractures W/ bridging callus, the Stable. Bridging callus is
Heali ty should be showing fracture is usually being reorganized as
ng bridging callus & are stable. However, the lamellar bone. There is
stable. However, the strength of this callus, increased rigidity.
strength of this callus, especially w/ torsional Ligamentous healing
especially w/ torsional load, is significantly less across the ankle joint is
load, is significantly less than that of normal well established
than that of normal bone. lamellar bone. Confirm
Confirm this w/ PE & x- w/ PE
rays
Stage Inflammatory phase Beginning of reparative Reparative phase Reparative phase Reparative phase / early
X-Ray Callus (-). Fracture None to very early Bridging callus is visible Bridging callus is visible Bridging callus is visible
lines are visible. callus as a small amount of & indicates increasing across the fracture. W/
fluffy material on the rigidity. W/rigid fixation, fracture consolidation,
periosteal surface of less callus is seen & fracture lines are less
cortical bone. Fractures fracture lines are less visible. Healing w/
rigidly fixed w/ screws & distinct. Less bridging endosteal callus
plates : callus may not be callus is noted & healing predominates. There is
visible, because there is w/ endosteal bone evidence of
primary bone healing. predominates incorporation of bone
Fractures treated in a graft.
cast, expect more callus
formation. There is a
consolidation of the
fracture & filling in of
lucent lines
Presc Preca Ankle & leg are Patients in a long cast Unstable fractures or Patients undergoing Avoid heavy pounding
riptio u- immobilized in either or external fixator do those w/ limited fixation conservative treatment activities
n tions a cast, splint, fixation not have stable are still in a cast may not yet have stable
or traction fractures fractures
ROM Rigidly fixed fractures Rigidly fixed fractures : Rigidly fixed fractures : Rigidly fixed fractures : Rigidly fixed fractures :
: active ROM at MTP active ROM at MTP & active ROM to ankle, MTP begin active ROM in all begin more aggressive
& knee joints; gentle knee joints; active ROM joints & knee planes of the ankle & resistive exc. in all
active ROM to the to the ankle out of Nonrigidly fixed fractures : subtalar joint. Nonrigidly planes of the ankle &
ankle while in a splint or bivalve cast. active ROM to the MTP fixed fractures : range subtalar joint.
compressive Nonrigidly fixed joints, ankle & knee as the ankle & knee as the Nonrigidly fixed
dressing. fractures : active ROM immobilization devices immobilization device fractures : begin active
Nonrigidly fixed at the MTP joints. allow allows. Continue active & active-assistive as
fractures : ROM at ROM to MTP joints well as passive ROM of
the MTP joints. the ankle & subtalar
joints. Patients in a cast
may actively range the
MTP joints & perform
isometric exc. of the
ankle & subtalar joints
within their cast.
Muscl No strengthening exc. Rigidly fixed fractures : Rigidly fixed fractures : Rigidly fixed fractures : Rigidly fixed fractures :
e to the ankle or foot. isometric exc. to isometric exc. to continue isometric exc. begin more aggressive
Streng Quadriceps isometric dorsiflexors & dorsiflexors & to dorsiflexors & resistive exc. to
th exc. as tolerated plantarflexors of the plantarflexors of the plantarflexors of the dorsiflexors &
ankle & toes; no ankle. No resistive exc. to ankle; no resistive exc. plantarflexors, as well as
resistive exc.; isometric long flexors & extensors to long flexors & the invertors & evertors.
quadriceps exc. of the toes. Quadriceps extensors of the toes; Nonrigidly fixed
Nonrigidly fixed strengthening continues continue quadriceps fractures : begin gentle
fractures : no Nonrigidly fixed fractures : isotonic strengthening patient controlled
strengthening or gentle isometric exc. to Nonrigidly fixed resistive exc.
resistive exc. dorsiflexors & fractures : continue
plantarflexors within a gentle isometric exc. to
cast. No resistive exc. to dorsiflexors &
the long flexors & plantarflexors within a
extensors of the toes. cast; no resistive exc. to
Quadriceps strengthening the long flexors &
continues. extensors of the toes.
Quadriceps
strengthening
continues.
Functi NWB stand/pivot NWB stand/pivot NWB stand/pivot transfers Rigidly fixed fractures : Rigidly fixed fractures :
onal transfers & transfers; ambulation & ambulation w/ AD begin PWB w/ 3-point progress from partial to
Act. ambulation w/ AD w/ AD stance. For fractures w/ FWB as tolerated for
evidence of healing, transfers & ambulation
ambulation w/ AD using AD as necessary.
Non rigidly fixed
fractures : begin PWB
using AD
Weigh None None None None for fractures that Toe-touch to FWB
t have not shown
Bearin evidence of healing.
g PWB for fractures that
are nontender to
palpation & appear
stable on radiograph
21
PENANGANAN FRAKTUR ANKLE

Bone Stabili None None to minimal Acute fractures should be W/ bridging callus, the Stable, except for the
Heali ty showing bridging callus & fracture is usually most comminuted
ng are stable. However, the stable. However, the fractures
strength of this callus, strength of this callus,
especially w/ torsional especially w/ torsional
load, is significantly less load, is significantly less
than that of normal bone. than that of normal
bone. Confirm w/ PE
phase
X-Ray Callus (-) No changes noted. Bridging callus is visible Bridging callus is visible Rigidly fixed bones
Fracture lines are as a small amount of & indicates increased should show a
visible; no callus fluffy material on the rigidity. W/rigid fixation, disappearance of the
present periosteal surface of less callus is seen & fracture line. Fractures
cortical bone. Fractures fracture lines are less treated in a cast show a
rigidly fixed w/ screws & distinct. Healing w/ small amount of fluffy
plates : callus may not be endosteal bone callus at the medial
visible, because there is a predominates malleolus & along the
consolidation of the shaft of the distal fibula.
fracture & filling in of
lucent lines. Amount of
callus deposition is less
than that at a midshaft
fracture
Presc Preca Patients treated in long Keep unstable fractures or Keep unstable fractures Essentially none
riptio u- leg cast or external those w/ limited fixation in or those w/ limited
n tions fixation do not have a cast or cam walker. fixation in a cast or cam
stable fractures Stable fractures are out of walker. Stable fractures
a cast. are out of a cast.
ROM Rigidly fixed fractures Rigidly fixed fractures : Rigidly fixed fractures : Rigidly fixed fractures : Rigidly fixed fractures :
: active ROM at MTP active ROM at MTP & active ROM to ankle, MTP active, active-assistive active, active-assistive
21
& knee joints. No knee joints. No ankle joints & knee & passive ROM in all & passive ROM in all
ankle ROM. ROM. Nonrigidly fixed fractures : planes of the ankle & planes of the ankle &
Nonrigidly fixed Nonrigidly fixed active ROM to the MTP subtalar joint. subtalar joint.
fractures : ROM at fractures : active ROM joints. Range the ankle & Nonrigidly fixed Nonrigidly fixed
the MTP joints. No at the MTP joints. No knee as immobilization fractures : begin active fractures : begin active
ROM at ankle or knee ROM at ankle or knee devices allow & active-assistive ROM & active-assistive ROM
to the ankle & subtalar to the ankle & subtalar
joint. Patients still in a joint. Patients still in a
cast may actively range cast may actively range
the MTP joints & try to the MTP joints & try to
actively range the ankle actively range the ankle
in their casts in their casts
Muscl No strengthening exc. Rigidly fixed fractures : Rigidly fixed fractures : For rigidly & nonrigidly Rigidly fixed fractures :
e to ankle or foot. isometric exc. to isometric & isotonic exc. fixed fractures, begin begin progressive
Streng Quadriceps isometric dorsiflexors & to dorsiflexors & resistive exc. to resistive exc. to
th exc. as tolerated plantarflexors of toes & plantarflexors of the dorsiflexors & dorsiflexors &
ankle. No resistive exc. ankle, evertors & plantarflexors as well as plantarflexors, as well as
Nonrigidly fixed invertors of the ankle & invertors & evertors of the invertors & evertors.
fractures : no foot. No resistive exc. the ankle. Nonrigidly fixed
strengthening exc. prescribed. Quadriceps fractures : continue
strengthening continued. gentle resistive exc.
Nonrigidly fixed fractures :
gentle isometric exc. to
dorsiflexors &
plantarflexors within a
cast. No resistive exc.
prescribed. Quadriceps
strengthening continued.
Functi NWB stand/pivot NWB stand/pivot NWB stand/pivot transfers Rigidly fixed fractures : Rigidly fixed fractures :
onal transfers & transfers; ambulation & ambulation w/ AD for PWB to FWB w/ AD for PWB to FWB as
Act. ambulation w/ AD w/ AD fractures w/ little fractures showing tolerated for transfers &
evidence of healing. Toe- evidence of healing. Use ambulation, using AD as
touch to PWB w/ AD for AD as necessary. necessary.
fractures showing Nonrigidly fixed Nonrigidly fixed
evidence of healing. fractures : toe-touch to fractures : begin PWB.
PWB using AD for AD required for transfers
transfers & ambulation & ambulation
Weigh None, except WB as None, except for stable None for fractures PWB to FWB PWB to FWB
t tolerated for fractures of the distal showing little evidence of
Bearin nondisplaced distal fibula. Toe-touch WB for healing. PWB for fractures
g fibula fractures rigidly fixed fractures that are nontender to
palpation & appear stable
on radiography. WB as
tolerated for nondisplaced
distal fibula fractures.
22
PENANGANAN FRAKTUR TALAR

Bone Stabili None None to minimal Some stability at fracture Increasing stability. Fractures treated w/
Heali ty site. There is some callus There is callus internal fixation are
ng formation, but the formation, but the stable. Talar neck
strength of this callus, strength of this callus, fractures that are not
especially w/ torsional especially w/ torsional rigidly fixed may not be
load, is significantly lower load, is significantly stable
than that of normal bone. lower than that of
The foot requires further normal lamellar bone.
protection to avoid The foot requires further
refractures. Confirm w/ PE protection to avoid
& radiography. refracture. Confirm w/
PE & radiography
Stage Inflammatory phase Beginning of reparative Reparative phase Reparative phase Reparative / early
X-Ray Callus (-); visible No changes noted. The tarsal bone, which The fracture lines is less Tarsal bones show that
fracture lines. Fracture lines are mainly cancellous in distinct. In the tarsal fracture lines are
visible; no callus composition, w/ minimal bones, which are mainly disappearing. This is
formation periosteum, begin to cancellous, no more obvious w/
22
show consolidation of the appreciable amount of fracture that have had
fracture & filling in of callus is visible because internal fixation. The
lucent lines. W/ increased the periosteum is thin. amount of callus
rigidity, lucency formation is significantly
disappears & healing w/ less than in midshaft
endosteal callus long bone fractures
predominates because because the periosteum
there is little periosteum is quite thin in this
region
Presc Preca Fixation is not rigid Fixation is not rigid No passive ROM Nonrigidly fixed
riptio u- unless the patient unless the patient has fractures may need to
n tions has had ORIF. Avoid had ORIF. Avoid passive limit the amount of WB
passive ROM ROM & the performance of
resistive exc.
ROM Active ROM of the Rigidly fixed fractures Rigidly fixed fractures : Rigidly fixed fractures :
toes & MTP joints as of the talus may begin begin active, active- active, active-assistive
well as the knee. active ankle & subtalar assistive ROM in & passive ROM at the
Before casting, do not ROM. Continue MTP dorsiflexion & ankle & subtalar joints.
move the ankle & joints exc. Patients who plantarflexion as well as Nonrigidly fixed
subtalar joint unless have not had internal inversion & eversion at fractures : allow active
rigidly fixed. fixation may range the the ankle & subtalar ROM at the MTP joints &
MTP joints only joint, out of the cast. isometric exc. of the
Nonrigidly fixed ankle & subtalar joints
fractures : actively out of the casts
range the MTP joints as
well as ankle & subtalar
joints within or w/o a
cast.
Muscl No strengthening exc. Rigidly fixed fractures Rigidly fixed fractures : Rigidly fixed fractures :
e to ankle & foot. may begin isometric begin isometric exc. out begin gentle resistive
Streng exc. in dorsiflexion & of the cast. exc. to dorsiflexors &
th plantarflexion as well Nonrigidly fixed plantarflexors, invertors
as inversion & eversion fractures : continue & evertors & flexor &
out of the bivalve cast isometric exc. at the extensor of the toes.
or cam walker ankle & subtalar joint in Nonrigidly fixed
the cast. Continue fractures : no resistive
quadriceps exc.
strengthening
Functi NWB stand/pivot Toe-touch WB transfers Rigidly fixed fractures : Rigidly fixed fractures :
onal transfers & w/ AD for rigidly fixed PWB for transfers & progress to FWB as
Act. ambulation w/ AD talar fractures ambulation w/ AD. tolerated for transfers &
Nonrigidly fixed ambulation, using AD as
fractures : continue necessary.
NWB transfers & Nonrigidly fixed
mobilization fractures : NWB or PWB.
They require the use of
AD for transfers &
ambulation
Weigh None Talar fractures that Rigidly fixed fractures : Rigidly fixed fractures :
t have been rigidly fixed begin PWB as tolerated PWB to FWB
Bearin may begin toe-touch in a cast Nonrigidly fixed
g WB Nonrigidly fixed fractures : NWB to PWB
fractures : must remain
NWB
23
PENANGANAN FRAKTUR CALCANEAL

Bone Stabili None None to minimal Some stability at fracture Increasing stability. Fractures treated w/
Heali ty site. There is some callus There is callus internal fixation are
ng formation, but the formation, but the stable.
23
strength of this callus, strength of this callus,
especially w/ torsional especially w/ torsional
load, is significantly lower load, is significantly
than that of normal bone. lower than that of
The foot requires further normal lamellar bone.
protection to avoid The foot requires further
refractures. Confirm w/ PE protection to avoid
& radiography. refracture. Confirm w/
PE & radiography
phase
X-Ray Callus (-); visible No changes noted. The tarsal bone, which The fracture lines is less Tarsal bones show that
fracture lines. Fracture lines are mainly cancellous in distinct. In the tarsal fracture lines are
visible; no callus composition, w/ minimal bones, which are mainly disappearing. This is
formation periosteum, begin to cancellous, no more obvious w/
show consolidation of the appreciable amount of fracture that have had
fracture & filling in of callus is visible because internal fixation. The
lucent lines. W/ increased the periosteum is thin. amount of callus
rigidity, lucency formation is significantly
disappears & healing w/ less than in midshaft
endosteal callus long bone fractures
predominates because because the periosteum
there is little periosteum is quite thin in this
region
Presc Preca Fixation is not rigid Fixation is not rigid All calcaneus fractures are No passive ROM Nonrigidly fixed
riptio u- unless the patient unless the patient has still in NWB short leg cast fractures may need to
n tions has had ORIF. Avoid had ORIF. Avoid passive limit the amount of WB
passive ROM ROM & the ability to perform
resistive exc.
ROM Active ROM of the Rigidly & nonrigidly Rigidly fixed fractures : Rigidly fixed fractures : Rigidly fixed fractures :
toes & MTP joints & fixed fractures may still casted. Continue begin active ROM in active & active-assistive
knee. Before casting, range the MTP joints active ROM to the MTP dorsiflexion & as well as passive ROM
do not move the only. joints as well as isometric plantarflexion as well as at the ankle & subtalar
ankle & subtalar joint exc. of the ankle, inversion & eversion to joints.
unless rigidly fixed. plantarflexion & the ankle & subtalar Nonrigidly fixed
dorsiflexion, inversion & joint, out of the cast. fractures : actively
eversion in the cast. Nonrigidly fixed range the MTP joints &
Nonrigidly fixed fractures : fractures : actively perform isometric exc.
continue active ROM at range the MTP joints as of the ankle & subtalar
MTP joints only. The well as ankle & subtalar joints within their casts
patient is still in a cast. joints in or out of a cast.
Muscl No strengthening exc. Rigidly fixed calcaneal Rigidly fixed fractures : Rigidly fixed fractures : Rigidly fixed fractures :
e to ankle & foot. fractures may begin begin isometric exc. to begin isometric exc. out begin gentle resistive
Streng isometric exc. in the dorsiflexors & of the cast. exc. to the dorsiflexors
th dorsiflexion & plantarflexion of the ankle Nonrigidly fixed & plantarflexors,
plantarflexion as well & the invertors & evertors fractures : continue invertors & evertors &
as inversion & eversion in the cast. isometric exc. at the flexor & extensor of the
in the cast only Nonrigidly fixed fractures : ankle & subtalar joint in toes.
o strengthening exc. the cast. Continue Nonrigidly fixed
quadriceps fractures : no resistive
strengthening exc.
Functi NWB stand/pivot NWB stand/pivot Rigidly fixed fractures of Rigidly fixed fractures : Rigidly fixed fractures :
onal transfers & transfers for calcaneus the calcaneus & talus may PWB for transfers & progress to FWB as
Act. ambulation w/ AD fractures continue PWB stand/pivot ambulation w/ AD. tolerated for transfers &
transfers & a 3-point gait Nonrigidly fixed ambulation, using AD as
fractures : continue necessary.
NWB transfers Nonrigidly fixed
fractures : NWB or PWB
& require the use of AD
for transfers &
ambulation
Weigh None Calcaneus fractures are Rigidly fixed fractures : Rigidly fixed fractures : Rigidly fixed fractures :
t NWB continue toe-touch to begin PWB as tolerated PWB to FWB
Bearin PWB. in a cast Nonrigidly fixed
g Nonrigidly fixed fractures : Nonrigidly fixed fractures : NWB to PWB
NWB in a short leg cast. fractures : must remain
NWB
24
PENANGANAN FRAKTUR MIDFOOT

Bone Stabili None, except stress None to minimal Usually stable. Acute W/ bridging callus, the Stable.
Heali ty fracture of the fractures should show fracture is usually
ng navicular bridging callus. Confirm stable. Confirm w/ PE
w/ PE & radiography/ W/
ligamentous injuries that
occurs in Lisfranc
fracture/dislocations &
tarsal bone avulsions, the
reconstruction may not
yet be stable secondary
to the slower healing of
ligaments.
phase
X-Ray Callus (-) No changes to early Bridging callus is visible Bridging callus is visible Callus is seen in all
callus noted in the as a fluffy material on the in cortical bone, fractures in cortical
periosteal aspects of periosteal surface of indicating increased regions of bone. Tarsal
the bone. cortical bone. The tarsal rigidity. Healing w/ bones show fracture
bones, which are mainly endosteal bone lines beginning to
cancellous in composition, oredominates. In the disappear. Trabeculae
begin to show region of the tarsal reform & strengthen
consolidation & filling in of bone, which are mainly over time
lucent fracture lines. W/ cancellous, an
increased rigidity, less appreciable amount of
bridging callus & lucency callus is not seen
are noticed, & healing w/ because the cortex is
endosteal callus quite thin, but the
predominates. In stress fracture line is less
fractures & nonunions of distinct
the tarsal navicular, a
fibrous nonunion w/ a
smooth fracture edge
may be observed
Presc Preca Fixation is not rigid Fixation is rigid & The fracture/dislocation is Avoid passive ROM to A rigid shoe or cam
riptio u- unless the patient stable only for treated not fully stable unless the the midfoot. Stability of walker can be used as
n tions has had ORIF. No w/ ORIF. rigid fixation device is in fracture/dislocations not necessary
24
ROM to the midfoot. place. However, the full unless rigid fixation
fractures is still not fully devices in place.
healed & cannot bear
weight.
ROM Active ROM to the Active ROM to the toes Active ROM to toes & MTP Gentle active to active- Active, active-assistive
toes & MTP joints. & MTP joints joints. If out of cast, assistive to gentle & passive ROM to the
gentle active ROM to the passive ROM as ankle & subtalar joints
ankle & subtalar joint. tolerated to the ankle &
subtalar joint if not in a
cast
Muscl No strengthening exc. No resistive exc. to the Isometric exc. to the Isometric exc. & isotonic Gentle resistive exc. to
e to ankle & foot. long flexor & extensors dorsiflexors & exc. to the ankle & the dorsiflexors &
Streng of the toes & MTP plantarflexors of the subtalar joint if not in a plantarflexors, evertors,
th joints. Isometric exc. to ankle. No resistive exc. to cast invertors, long flexors &
the dorsiflexors & the long flexors or extensors of the toes
plantarflexors & extensors of the toes.
invertors & evertors of
the ankle are
performed in the cast.
Functi NWB stand/pivot NWB stand/pivot PWB or NWB stand/pivot PWB is permitted during Partially to FWB
onal transfers & transfers & ambulation transfers & ambulation w/ transfers except in transfers & ambulation
Act. ambulation w/ AD. w/ AD, depending on AD, depending on type of fractures treated w/ w/ AD or independently,
PWB transfers & type of fracture. fracture ORIF as healing dictates
ambulation w/ AD for PWB to WB as tolerated
some fractures of the w/ AD for stable
navicular & cuboid fractures of the
navicular & cuboid.
Weigh PWB for cortical None except for stable None for patients w/ ORIF, Depending on PWB to FWB
t avulsion & tuberosity fractures of the tarsal or multiple cuneiform tenderness at fracture
Bearin fractures of navicular, navicular & cuboid. fractures & displaced site & callus formation,
g as well as avulsion or stress fractures of the WB is partial or full, w/
nondisplaced tarsal navicular. PWB as the exception of any
fractures of cuboid. tolerated for all other fracture w/ ORIF
Remainder are NWB. fractures, including
percutaneous pinning
after hardware removal.
25
PENANGANAN FRAKTUR FOREFOOT

Bone Stabili None None to minimal Acute fracture should be W/ bridging callus, the Stable.
Heali ty showing bridging callus & fracture is usually
ng the fracture is usually stable. Confirm w/ PE
stable. This is confirmed
by PE & radiography.
However, the strength of
this callus, especially w/
torsional load, is
significantly lower than
that of normal bone.
phase
X-Ray Callus (-) No changes to early Bridging callus is visible Bridging callus is visible Abundant callus is seen
callus noted in the as a fluffy material on the w/ increased rigidity. in all fractures w/ the
periosteal aspects of periosteal surface of the Less bridging callus is exception of the
the bone. bone. W/ increased noted & healing w/ sesamoids. The fracture
rigidity, less bridging endosteal callus line begin to disappear.
callus is noted, & healing predominates. Fracture W/ time, there is
w/ endosteal callus line is less distinct. reconstitution of the
predominates. For stress Sesamoid fractures do medullary canal.
fractures & nonunions of not show callus but the Apophyseal areas do not
the sesamoids & 5th fracture line is less produce as much callus
metatarsal, a fibrous distinct. as diaphyseal regions.
nonunion w/ smooth
fracture edges may be
observed
Presc Preca No passive ROM No passive ROM No passive ROM No repetitive impact
riptio u- exc.
25
n tions
ROM For stable phalangeal Stable phalangeal Stable phalangeal Active & active-assistive Active, active-assistive
fractures, active ROM fractures : active ROM fractures : full active ROM to gentle passive ROM & passive ROM to the
to MTP joints. to the MTP joints to the metatarsal joints to all phalangeal, MTP, IP & ankle joints
For fractures of the Fractures of 1st Metatarsal fractures out metatarsal & ankle
sesamoids, 1st metatarsal & Jones of cast: active ROM to joints.
phalanx & 1st fracture : no ROM metatarsal joints. Active
metatarsal, no ROM Sesamoids & 1st to active-assistive ROM to
phalanx : immobilized, the ankle.
no ROM Fractures of the 1st & 5th
Fractures of the 2nd 5th metatarsal (Jones
metatarsal : active fracture), sesamoids & 1st
ROM to the MTP & IP phalanx : immobilized, no
joints ROM
Muscl No strengthening exc. Stable phalangeal Stable phalangeal Isometric & isotonic exc. Progressive resistive
e fractures : no fractures : isotonic exc. to w/ resistance to ankle exc. to the longflexors,
Streng strengthening exc. to the long flexors & dorsiflexors, extensors of the toes,
th the long flexors & extensors of the toes. plantarflexors, evertors dorsiflexors,
extensors of the toes. Metatarsal fractures : & invertors. Isometric & plantarflexors, evertors
Metatarsal fractures : isometric & isotonic isotonic strengthening & invertors of the ankle
no exc. however, strengthening exc. to the exc. to longflexors &
isometric strengthening ankle plantarflexors, extensors of the toes
exc. to all the ankle dorsiflexors, evertors &
musculature invertors.
Functi NWB stand/pivot NWB stand/pivot WB transfers & Stable fractures : FWB FWB transfers &
onal transfers & transfers & ambulation ambulation w/ AD as transfers & ambulation ambulation
Act. ambulation w/ AD for w/ AD for fractures of needed. PWB to NWB Fractures of sesamoids,
fractures of sesamoi, the 1st phalanx, transfers & ambulation for 1st & 5th metatarsal & 1st
1st phalanx & 1st & 5th sesamoids, 1st & 5th 1st phalanx, 1st & 5th phalanx : PWB to FWB
metatarsals. metatarsals. metatarsals & sesamoids. transfers & ambulation
NWB as tolerated, WB as tolerated
transfers & transfers 7 ambulation
ambulation for stable for single lesser
fractures of phalangeal fractures
metatarsals, lesser
phalanges & lesser
metatarsal
Weigh WB to tolerance for Lesser phalangeal & Stable fractures, lesser FWB for phalangeal & FWB
t stable fractures of stable metatarsal phalangeal fractures & metatarsal fractures.
Bearin phalanges & lesser fractures : WB as metatarsal fractures : WB PWB to FWB for
g metatarsals. tolerated. as tolerated fractures of sesamoids,
NWB for fractures of Sesamoid, 1st & 5th Fractures of the 1st 1st & 5th metatarsal & 1st
the sesamoid, 1st metatarsal fractures : phalanx, 1st & 5th phalanx
phalanx & 1st & 5th NWB metatarsal (Jones
metatarsals. fracture) & sesamoids :
NWB to PWB
26
PENANGANAN FRAKTUR C1 (Jefferson Fracture)
0 1 Week 2 4 Weeks 4 8 Weeks 8 12 Weeks 12 16 Weeks

Bone Stabili Unstable. The degree Unstable. Stability Early healing at the Bone stability achieved Stable.
Heali ty of instability is continues to be a fracture site & early graft but ligamentous
ng dependent upon function of intact bony consolidation give added instability may persist
intact bony & & ligamentous stability.
ligamentous elements, internal
structures, internal fixation & external
fixation & external immobilization
immobilization
Stage Inflammatory phase Reparative phase Reparative phase Remodeling phase Remodeling phase
of
bone
26
healin
g
Stage Fibrovascular stroma Trabeculation of fusion Remodeling phase
of arises mass is occurring.
arthro Remodeling is an
desis ongoing process
X-Ray Fracture lines & bone Fracture lines & graft Fracture lines are less Fracture lines begin to Healed fractures;
graft, if used, are remain visible. Early obvious; bone graft is disappear. Trabeculation maturation of bone graft
visible callus formation occurs consolidating. Callus is of bone graft is at
but is usually not seen observed & it may be varying stages.
minimal in cervical spine
fractures because of the
small size of the bones.
Presc Preca Cervical spine is Maintain cervical spine Maintain immobilization Be aware of No contact sports
riptio u- immobilized. Avoid immobilization ligamentous instability
n tions overhead ROM of
upper extremities.
ROM No ROM is allowed to No ROM to the cervical Avoid ROM to the cervical Gentle active ROM to Active, gentle passive
the cervical spine. spine. Active ROM to spine. Active ROM to the the cervical spine if the ROM to the cervical
Gentle active ROM to the upper & lower upper & lower fracture has healed at spine
upper & lower extremities extremities. 10 to 12 weeks.
extremities Gentle passive ROM
may begin if the
fracture has healed at
12 weeks.
Muscl No strengthening exc. No strengthening exc. No strengthening exc. to Isometric strengthening Isometric strengthening
e allowed to the to the cervical spine. the cervical spine. exc. to the cervical exc. to the cervical
Streng cervical spine. Isometric exc. to the Isometric exc. to the spine as tolerated. spine muscles
th Isometric exc. to the abdominal, gluteal & abdominal, gluteal &
abdominal, gluteal & quadriceps. quadriceps.
quadriceps muscles.
If the cervical spine is
immobilized, gentle
strengthening exc. to
both upper
extremities.
Functi Bed mobility : log- Bed mobility : log- Bed mobility : log-rolling Independent in bed Independent in transfers
onal rolling w/ assistance. rolling w/ assistance. Transfers & ambulation : mobility, transfers & & ambulation
Act. Transfers & Transfers & ambulation w/ AD as needed. ambulation
ambulation : w/ AD & : w/ AD & w/
w/ assistance. assistance.
Weigh WB w/ AD. WB as tolerated w/ AD FWB FWB FWB
t
Bearin
g
27
PENANGANAN CERVICAL SPINE COMPRESSION & BURST FRACTURES

Bone Stabili Dependent upon Stability continues to Early healing at the Bone stability achieved Stable.
Heali ty intact bony & be a function of intact fracture site & early graft but ligamentous
ng ligamentous bony & ligamentous consolidation give added instability may persist
27
elements, internal elements, internal stability.
fixation & external fixation & external
immobilization immobilization
of
bone
healin
g
Stage Bone graft is at a Fibrovascular stroma Trabeculation of fusion Remodeling phase
of similar phase arises mass is occurring.
X-Ray Fracture lines & bone Fracture lines & graft Fracture lines become Fracture lines begin to Healed fractures;
graft are visible remain visible. Early obscured; bone graft is disappear. Trabeculation maturation of bone graft
callus may be seen consolidating. of bone graft is at
varying stages.
Presc Preca Cervical spine is Cervical spine No passive ROM. Maintain Be aware of No contact sports
riptio u- immobilized. Avoid immobilized immobilization in patients ligamentous instability
n tions overhead ROM of w/ unstable injuries
upper extremities.
ROM No ROM is allowed to No ROM is allowed to Avoid ROM to the cervical Gentle active ROM to Active, gentle passive
the cervical spine. the cervical spine. spine. the cervical spine, if the ROM to the cervical
Gentle active ROM to Active ROM to the fracture has healed at spine
upper & lower upper & lower 10 to 12 weeks.
extremities extremities Passive ROM is allowed
at 12 weeks if the
fracture has healed.
abdominal, gluteal & quadriceps. Light quadriceps.
quadriceps muscles. isotonic exc. to the
If the cervical spine is upper extremities
immobilized, gentle
both upper
extremities.
Functi Bed mobility : log- Bed mobility : log- Bed mobility : log-rolling Independent in bed Independent in transfers
onal rolling w/ assistance. rolling w/ assistance. Transfers & ambulation : mobility, transfers & & ambulation
Act. Transfers & Transfers & ambulation w/ AD as needed. ambulation
ambulation : w/ AD & : w/ AD
w/ assistance.
Weigh WB w/ AD. WB w/ AD FWB FWB FWB
t
28
PENANGANAN CERVICAL SPINE UNILATERAL & BILATERAL FACET DISLOCATION

Bone Stabili Complex, depending Stability continues to Early healing at the Bone stability achieved Stable.
Heali ty on intact bony & be a function of intact fracture site & early graft but ligamentous
ng ligamentous bony & ligamentous consolidation give added instability may persist
elements, internal elements, internal stability.
of
bone
healin
g
Stage Bone graft is at a Fibrovascular stroma Trabeculation of fusion Remodeling phase
of similar phase arises mass is occurring.
X-Ray If an associated Fracture lines & graft Fracture lines become Fracture lines begin to Any fractures that were
fracture was present, remain visible. Early obscured; bone graft is disappear. Trabeculation present should be
a fracture line is callus may be seen consolidating. of bone graft is at healed. There is
visible & if a fusion varying stages. maturation of bone graft
was performed, the in surgically treated
bone graft is visible. patients. Ligamentous
Facets should appear instability may still be
reduced & spinous present as evidenced by
processes aligned motion on dynamic
active flexion/extension
radiographs
Presc Preca Cervical spine is Maintain cervical spine Maintain cervical spine Be aware of persistent No contact sports
riptio u- immobilized. immobilization immobilization ligamentous instability
n tions
ROM No ROM is allowed to No ROM to the cervical No ROM to the cervical Gentle active & passive Active, gentle, passive
the cervical spine. spine. Active ROM to spine. Active ROM to the ROM to the cervical ROM to the cervical
Gentle active ROM to the upper & lower upper & lower extremities spine if the fracture has spine
upper & lower extremities healed.
extremities
28
abdominal, gluteal & quadriceps in quadriceps in
quadriceps in neurologically intact neurologically intact
neurologically intact patients. If the cervical patients. If the cervical
patients. If the spine is immobilized, spine is immobilized,
cervical spine is gentle strengthening gentle strengthening exc.
immobilized, gentle exc. to both upper to both upper & lower
strengthening exc. to extremities in intact extremities in intact
both upper patients. Passive ROM patients. Passive ROM in
extremities in intact in neurologically neurologically impaired
patients. Passive impaired patients to patients to prevent
ROM in neurologically prevent contractures contractures
impaired patients to
prevent contractures
Functi Bed mobility : log- Bed mobility : log- Bed mobility : log-rolling Independent in bed Neurologically intact
onal rolling w/ assistance. rolling w/ assistance. w/ assistance. mobility, transfers & patients are
Act. Transfers & Transfers & ambulation Transfers & ambulation : ambulation in independent in transfers
ambulation : w/ AD & : w/ AD & w/ w/ AD & w/ assistance. neurologically intact & ambulation
w/ assistance. assistance. patients
Weigh FWB w/ AD in FWB w/ AD as needed FWB w/ AD as needed FWB in neurologically FWB for neurologically
t neurologically intact intact patients intact patients
Bearin patients.
g
29
PENANGANAN THORACOLUMBAR SPINE FRACTURES

Bone Stabili Complex, depending Stability continues to Early healing at the Bone stability is Stable.
Heali ty on intact bony & be a function of intact fracture site & early graft established but
ng ligamentous bony & ligamentous consolidation provides ligamentous instability
elements, internal elements, internal some stability. may persist
Stage Inflammatory phase Early reparative phase Reparative phase Remodeling phase Remodeling phase
of
bone
healin
g
Stage Bone graft is at a Fibrovascular stroma Early trabeculation of Remodeling phase
of similar phase arises the fusion mass seen at
arthro 12 week. Remodeling is
desis an ongoing process
X-Ray Fracture line is visible Fracture lines & bone Fracture lines become Fracture lines begin to Healed fractures;
& not incorporated graft remain visible. obscured; bone graft is disappear. Trabeculation maturation of fusion
Early callus may be consolidating. of bone graft is at mass. Bone fragments
seen. The amount of varying stages. in spinal canal
callus formation is associated w/ a burst
minimal compared to fracture may show signs
the long bones of resorption
Presc Preca Avoid flexion, sit-ups Avoid spinal flexion, No passive ROM to the No passive ROM to the Avoid extreme ROM
riptio u- & spinal rotation torsion & sit-ups thoracolumbar spine. thoracolumbar spine.
n tions Avoid rotator & flexion
movements to the
thoracolumbar spine.
ROM Active ROM to the No ROM to the At the end of 6 weeks, Active flexion, Active, active-assistive,
upper & lower thoracolumbar spine. active extension is extension, lateral gentle passive ROM to
extremities. No ROM Active ROM to the allowed to the bending & rotary the thoracolumbar spine
of the thoracolumbar upper & lower thoracolumbar spine for movement allowed to
29
spine allowed. extremities stable compression the thoracolumbar spine
fractures
Muscl Abdominal isometrics Abdominal isometrics No strengthening exc. to Trunk strengthening & Progressive resistive
e & gluteal & exc. Isotonic exc. w/ paraspinal muscles. paraspinal exc. to the paraspinal
Streng quadriceps sets. No light weights to the Isotonic exc. w/ weights to strengthening exc. once muscles
th strengthening exc. to upper & lower the upper & lower the fusion is solid or the
the spinal muscles extremities. No extremities. fracture is healed.
the spinal muscles
Functi Bed mobility : log- Bed mobility : log- Bed mobility : log-rolling Bed mobility : patients Independent transfers &
onal rolling. Avoid lying rolling. Avoid lying encouraged. can be prone by 12 ambulation
Act. prone prone Transfers & ambulation : weeks postoperatively.
Transfers & Transfers & ambulation w/ AD. Transfers & ambulation :
ambulation : to a : w/ AD. independent
chair using AD.
Weigh WB as tolerated w/ WB w/ AD WB w/ AD FWB FWB
t AD
Bearin
g
PE : Physical Examination
W/ : with
W/O : without
ORIF : Open reduction and Internal Fixation
WB : Weight Bearing
NWB : Non Weight Bearing
PWB : Partial Weight Bearing
FWB : Full Weight Bearing
AD : Assistive Devices
MCP : Metacarpophalangeal
MTP : Metatarsophalangeal
Inflammatory phase : The fracture hematoma is colonized by inflammatory cells, & debridement of the fracture begins.
Beginning of reparative phase : Osteoprogenitor cell differentiate into osteoblasts, which lay down woven bone.
Reparative phase : There is further organization of the callus, and formation of lamellar bone begins. Once callus is observed bridging
the fracture site, the fracture is usually stable. However, the strength of the callus, especially with torsional load, is significantly lower than
that of normal bone. Further protection of bone (if not further immobilization) is required to avoid refracture.
Remodeling phase : There is further organization of the callus, & formation of lamellar bone continues. Woven bone is replaced w/
lamellar bone. The process of remodeling takes month to years for completion (years for radial head).

PENANGANAN FRAKTUR (Time Table Hoppenfeld) - 1

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PENANGANAN FRAKTUR (Time Table Hoppenfeld) - 1

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1

PENANGANAN FRAKTUR KLAVIKULA

0 1 Week 2 Weeks 4 6 Weeks 6 8 Weeks 6 12 Weeks

0 1 Week 2 - 4 Weeks 4 6 Weeks 6 8 Weeks 8 12 Weeks

0 1 Week 2 Weeks 4 6 Weeks 8 12 Weeks

0 1 Week 2 Weeks 4 6 Weeks 8 12 Weeks

0 1 Week 2 Weeks 4 6 Weeks 6 8 Weeks 8 12 Weeks

0 1 Week 2 Weeks 4 6 Weeks 8 12 Weeks

0 1 Week 2 Weeks 4 6 Weeks 8 12 Weeks

0 1 Week 2 Weeks 4 6 Weeks 6 8 Weeks 8 12 Weeks

0 1 Week 2 Weeks 4 6 Weeks 8 12 Weeks 12 16 Weeks

0 1 Week 2 Weeks 4 6 Weeks 6 8 Weeks 8 12 Weeks

0 1 Week 2 Weeks 4 6 Weeks 6 8 Weeks 8 12 Weeks

0 1 Week 2 Weeks 4 6 Weeks 8 12 Weeks 12 16 Weeks

0 1 Week 2 Weeks 4 6 Weeks 8 12 Weeks

0 1 Week 2 - 4 Weeks 4 6 Weeks 8 12 Weeks 12 16 Weeks

0 1 Week 2 Weeks 4 8 Weeks 8 12 Weeks 12 16 Weeks

0 1 Week 2 Weeks 4 6 Weeks 8 12 Weeks

0 1 Week 2 Weeks 4 6 Weeks 8 12 Weeks 12 16 Weeks

0 1 Week 2 Weeks 4 6 Weeks 8 12 Weeks

0 1 Week 2 Weeks 4 6 Weeks 6 8 Weeks 8 12 Weeks

0 1 Week 2 Weeks 4 6 Weeks 6 8 Weeks 8 12 Weeks

0 1 Week 2 Weeks 4 6 Weeks 6 8 Weeks 8 12 Weeks

0 1 Week 2 Weeks 4 6 Weeks 6 8 Weeks 8 12 Weeks

0 1 Week 2 Weeks 4 6 Weeks 6 8 Weeks 8 12 Weeks

0 1 Week 2 Weeks 4 6 Weeks 6 8 Weeks 8 12 Weeks

0 1 Week 2 4 Weeks 4 8 Weeks 8 12 Weeks 12 16 Weeks

0 1 Week 2 4 Weeks 4 8 Weeks 8 12 Weeks 12 16 Weeks

0 1 Week 2 4 Weeks 4 8 Weeks 8 12 Weeks 12 16 Weeks

0 1 Week 2 Weeks 4 8 Weeks 8 12 Weeks 12 16 Weeks

ORIF : Open reduction and Internal Fixation

NWB : Non Weight Bearing

PWB : Partial Weight Bearing

FWB : Full Weight Bearing

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