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Submitted to: Dr.

Zakir Submitted by: Aamir Rauf Memon CMS #: 7690 Subject: Therapeutic Exercises & Techniques-II Semester: 6th Assignment # 03 References: Therapeutic Exercise by Kisner & Colby (5th Ed) page 320-324

Fracture
Structural break in the continuity of a bone, epiphyseal plate, or cartilaginous joint surfaces is called a fracture. Serious Soft tissue injury major artery or peripheral nerve involved. Central fracture Brain, Spinal cord, Viscera involved. Position of Fracture Fragments (Distal w.r.t Proximal segment) Nondisplaced Medial displaced Lateral displaced Distracted Over-riding with posterior & superior displacement Distracted & laterally rotated

Direction of Fracture w.r.t Longitudinal Axis Tranverse Longitudinal Oblique Spiral

Frequently occurring Comminuted Fracture patterns: Wedge-shaped or Butterfly pattern Two or Three-segmental level fracture Fracture with multiple fragments

Classification of Fractures
Site Diphyseal, Metaphyseal, Epiphyseal, Intra-articular Extent Complete, Incomplete Configuration Transverse, Oblique or Spiral, Comminuted Relationship of Fragments Undisplaced, Displaced Relationship to Environment Closed, Open Complications Local or System Related to Injury or Treatment Classification on the basis of the Forces acting Bending (Angulatory) Transverse or Oblique Fracture, Greenstick Fracture (Children) Twisting (Torsional) Spiral Fracture

Straight pulling (Traction) Avulsion Fracture Crushing (Compression) Compression Fracture, Torus (Buckle) Fracture in Children Repetitive microtrauma Fatigue or Stress Fracture Abnormal bone Pathological Fracture

MANAGEMENT GUIDELINES (Period of Immobilization)


Plane of Care 1. 2. 3. 4. Educate the patient the effects of Inflammation in Acute period the effects of Immobilization Bedridden patient maintain Strength & ROM in major muscle groups

Intervension 1. 2. 3. 4. Teach functional adaptations; Teach safe ambulation, bed mobility Ice, Elevation Intermittent muscle setting; Active ROM (above or below the immobilized region) Resistance exercises to major muscle groups not immobilized (preparation for future ambulation)

MANAGEMENT GUIDELINES (Postfracture/Postimmobilization)


Plane of Care 1. 2. 3. 4. 5. 6. Educate the patient Provide protection until radiologically healed Initial active exercises Joint & soft tissue mobility strength & muscle endurance Improve cardiopulmonary fitness

Intervension 1. Inform patient of limitations until fracture site is radiologically healed. Teach home exercises that reinforce interventions. 2. Use partial weight-bearing in lower limbs & nonstressful activities in the upper limbs. 3. Active ROM, gentle multiangle isometrics. 4. Initiate joint play stretching techniques (III-IV) with force applied proximal to healing fracture site. Apply force proximal to healing fracture site until radiologically healed. 5. As ROM increases & bone heals Initiate resistive & repetitive exercise 6. Initiate safe aerobic exercises which dont stress fracture site until it is healed.