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Treatment and Rehabilitation of Fractures - Ebook download as PDF File .pdf), Text File .txt) or read book online. carte fracturi. Treatment and Rehabilitation of Fractures by Stanley Hoppenfeld, , available at Book Depository with free delivery worldwide. Treatment and Rehabilitation of Fractures by Vasantha L. Murthy, , available at Book Depository with free delivery worldwide.
It is essential to communicate effectively crossing joints usually causes joint stiffness. Two-Point Gait In a two-point gait sometimes called hop-to gait. Endurance is the ability to do the same movement Active Range of Motion repeatedly. Mark Thomas, M. Stride length is the distance measured from heel tant after hip fracture.
Subsequent chapters focus on management of individual fractures. Each chapter on an individual fracture is organized by weekly postfracture time zones, from the day of injury through twelve weeks. Specific treatment strategies and rehabilitation protocols are then presented. More than illustrations complement the text. Product details Format Paperback pages Dimensions Table of contents I: Foundation ChaptersII: Lower Extremity FracturesIV: Spine FracturesInde show more.
In this exercise. Because of the torque generated at a lower extremity fracture site. They are used to increase overall cardiopulmonary function Open-Chain Exercise rather than to treat deficits after a specific fracture. Conditioning exercises increase endurance. Common conditioning exer- cises include riding a stationary bicycle or using a Plyometric Exercise treadmill. This exercise is performed by maximal muscle con- traction after a quick stretch. Concentric In concentric contraction.
They are performed at an adequate target heart rate for more than 20 minutes. Rehabilitation considerations for specifying fracture. In addition to muscle fiber hypertrophy. Muscles contracting in a con- These exercises increase performance while increas. Examples of closed-chain exer. This type of strengthening exercise is more com. Examples include leg muscle metabolism.
Application to Pathological Motion. Lindelow G. Svensson K. Acta squat is an eccentric. Rehabilitation of fractures. Muscle fibers shorten in concentric con- apart.
Eccentric contractions generate greater heat as well Ceder L. They carry a greater risk of postexer. Borquist L.
Statistical prediction of as greater force. The normal func. Mehta Arun JMB.
Acta Orthop Scand. When exercises are prescribed as Delisa J. Physical Examination of the Spine and Extremities. Rehabilitation Medicine: Principles and Practice. In isometric contractions.
Reiker O. Effect of physical activity on muscle and exercises should be specified only when there is good bone blood flow after fracture: Soderberg G. An Baltimore: Isometric Philadelphia: Thomgren KG. Physical Medicine and Rehabilitation. Orthop Scand. Costs of hip fracture: Eccentric change length in isometric contraction.
The biceps contracts concentrically while the triceps Braddom R. Norkin C. Levangie P. During eccentric contraction. Clinical Orthopaedic Rehabilitation. Modalities all have a predictable biologic elasticity. Skin and Pain and muscle Burn or anesthetic area Common subcutaneous tension Peripheral vascular disease Paraffin bath. Heat increases the metabolic rate and circulatory essary to be familiar with the specific physiologic demand at the area to which it is applied and.
Just as with pharmaco. It also reduces the firing rate of both muscle effect when externally applied. It is nec. Indications for its use include treatment of Superficial Heat postfracture contracture and subcutaneous adhesion. Because of this. This tem because it may interrupt system electronics.
Hot packs and radiant heat heat lamps implanted metal or a pacemaker or drug delivery sys- are used to heat the skin and subcutaneous tissues. The air. In the later upper extremity hand and wrist after fracture. The con- Heating may be applied directly using hot packs traindications to the use of ultrasound are somewhat thermal energy or by converting ultrasound acoustic controversial.
Short-wave and microwave diathermy are infrequently used because of limited The degree of weight bearing. In addition to the thermal effects. It should cold pack. The use of cold such as ground com husks is suspended by warm versus heat for pain reduction is patient specific. Indications for its use include postfracture muscle or have a tenuous vascular supply. Superficial heating methods do Indications for its use are limited to postfracture mus- not effectively reach muscle.
Hydrotherapy may include whirlpool or therapeutic Paraffin baths and fluidotherapy may provide either pool treatment. The benefits of therapeutic heat and exercise are treatment method and parameters.
Indications for this modality include pain and loss of distal upper extremity hand Cold. Cold produces its Like paraffin immersion. Short-wave diathermy selectively heats subcuta- neous tissue more effectively than superficial heat modalities. Hot packs and ultrasound are the heating heat concentration could lead to a bum or disruption of modalities most commonly used during postfracture fracture healing.
JLuidotherapy heats by numbing effect by decreasing the firing rate in periph- convection and conduction and is used for the distal eral receptors. The general uses of hydrotherapy are to: Although it is possi.
It is contraindicated when there is A paraffin bath. This is the most common form of heat prescribed Short-wave diathermy is contraindicated when there is after fracture. With phases of rehabilitation. Improve range of motion. DeLisa J. State of the Art Spray and stretch therapy consists of slow.
Statistical prediction of stimulate the quadriceps after a distal femur fracture. If there is persistent pool is a good way to advance weight bearing. In select instances.
Reviews in Physical Medicine and Rehabilitation. Thorngren KG. Electrical stimulation may be provided as part of a strengthening program after a fracture has healed. Treatment in a walk-tank or therapeutic followed by manual stretching. The stance phase. It is divided into two phases. A careful assessment of gait identifies problems that result in inefficient or limited ambulation and allows for their Stance Phase treatment. Figure Gait stance and the swing phase.
The goal of rehabilitation of lower extremity frac- to be exact. At this point. When the clinician evaluates the quality ing ambulation. Heel strike: The heel of the foot touches the essential for the practitioner to understand all aspects ground.
There are two components of push-off: Foot -flat occurs as the entire the weight line passes directly over the foot at mid-stance. Push-off occurs as the weight-bearing ground. As the body progresses forward. Foot-flat occurs as the entire plantar during double stance see Figure As the body continues to move ante. When the heel is lifted. Double stance: Both feet are on the ground. There are two com. Gravity assists the extremity in a forward swing.
The first component of swing phase is acceleration. Swing phase starts at the end of under the body and moving forward by momen- push-off when the toes lose contact with the tum Figure At mid-swing. During acceleration. The first component of the swing phase is acceleration Figure Swing phase starts at the end of push-off as the toes lose contact with the ground. As the leg approaches the terminus of its arc of motion.
At mid-swing.. Understanding the gait cycle facili- TABLE Components of the Gait Cycle tates the identification of gait abnormalities and treat- Standard Classification Alternate Classification a ment goals in the 1ater stage of rehabilitation.
If normal flexion and pelvic movement do not allow this functional limb length change. Toe-off Hip: Because the principal goal of prevents a terminal snap and positions the extremity rehabilitation after a fracture of the lower extremity is to accept weight as it approaches heel-strike.
Mid-stance Hip: Gait Analysis: Normal and Pathological Function. The Heel-strike Initial contact muscles that are the most active during each phase of Foot-flat Loading response the gait cycle are presented in Tables and Although this is Acceleration Hip: As the leg approaches the terminus of that may affect the fracture. Understanding of when and how muscles During mid-stance and mid-swing. Most of the muscles involved are active at the begin- centric and eccentric fashion see Table and ning and the end of the stance and swing phases.
Table summarizes the muscle tract in an eccentric rather than a concentric manner activity frequently considered during gait retraining see Table This may be significant if the torque after fracture.
Chapter 4. Stride length in. This is particularly impor. Step length normal: It is widened until the late stage of rehabilitation to increase the base Parameters of Gait of support and stability after fracture Figure Step length in. The following parameters of gait-step angle.
Stride length is the distance measured from heel tant after hip fracture. Step Width tion. Because of pain. Fractures of the femur or tibia disrupt the nor- walking. In frac- tured limb and shorter for the uninvolved limb. The parameters of gait must be normalized to restore Hirr-Knee-Ankle Movement cosmetic.
Speed Pelvic Rotation Normal walking speed is approximately 2. Speed slows with either reduced cadence or a The pelvis rotates medially anteriorly as the swing decrease in the step or stride length.
Step length is initially longer for the frac. If ing fully erect. Hip fractures and hip surgery impair the nor- present in the early and intermediate stages of rehabil. Flexion at the hip and knee and dorsiflexion of the ankle serve functionally to shorten a limb.
After decreasing the height needed to clear the swing-phase fracture. These movements can all be thought of as increasing or decreasing the functional length of a Knee Flexion in Stance lower extremity. Fractures of the hip or lumbar spine impair or extremity length is occasionally disrupted.
This limits the maximum height a person achieves eral and vertical up-and-down motion while walking. The net effect of this is to decrease The determinants of gait are the movements that vertical movement and concomitant energy cost while improve efficiency.
Two steps are Lateral movement of the pelvis over the leg in stance equal to one stride see Figure Knee flexion in stance is abnormal with. Cadence This both decreases the vertical amplitude of movement Cadence. This decreases as a result of pain. The opposite rotation lat- length. After fracture. The determinants of gait limb shortening during swing because of reduced include pelvic tilt. Stride Length Stride length is the distance measured from heel Pelvic Shift strike to heel strike of the same foot.
Pathologic changes in gait after a lower extremity the patient may use trunk extension before heel strike fracture occur as a consequence of shortening. This may fracture. The patient ture. A decrease in efficiency Figure A patient with a weak glu- to minimize the time spent on the fractured limb. Ankle and subtalar motion reduces energy cost by reducing the amplitude of movement and smoothing Short-Leg Gait the translation of movement. Although the gait remains abnormal in such an instance.
Vaulting Gait An analysis of the determinants of gait becomes The patient may plantar flex the short limb. Antalgic Gait This painful gait IS an attempt to avoid bearing weight on the fractured lower extremity. If gluteal weakness persists.
This is the uncompensated gluteus maximus lurch. If weakness or shortening persist. The opposite "long" leg may be other soft tissue contracture. Step length is reduced after any fracture of the lower extremity. This may be due to pain. Once a fractured limb is fully weight bearing. This teus maximus muscle may experience difficulty in preventing flex- may result from pain or anxiety and almost invariably ion of the trunk at heel strike and may use trunk extension gluteus follows any fracture of the lower extremity.
In an antalgic gait. Ankle and foot fractures If shortening has occurred after a lower extremity prevent normal ankle motion during gait. When actual shortening due to bone loss or functional shortening due to muscle shortening Gluteus Maximus Lurch e.
This throwing of the trunk to the side of the impaired gluteus medius is gluteus medius lurch. If this lurch persists.
Less frequently. To clear the foot during swing phase. A weak gluteus medius is ineffective in preventing the drop of the opposite hemipelvis dur- ing swing phase.
To compensate. FIGURE Steppage gait may occur from nerve or soft tissue trauma that leaves the patient unable to dorsiflex the foot in the swing phase. To clear the foot during the swing phase. Steppage and Circumducted or Abducted Gait This type of gait may result from peroneal nerve injury.
This throw. This is one of three basic compensations arise to prevent the gluteus medius lurch. The limb may be externally Trendelenburg gait. Gait Patterns after Fracture Example: Oblique midshaft tibial fracture that is Common gait patterns after fracture can be classi. With 4. When as with an as calcis fracture. Full weight bearing the injured limb.
Weight bearing as tolerated restricted weight bearing. Non-weight bearing advanced to the same position. This manifests itself during the or as tolerated. With restricted weight bearing. Because weight bear. Toe-touch weight bearing 3. Partial weight bearing. Gait Considerations with Lower Extremity Example: Partial weight bearing or toe-touch weight Fracture bearing after a tibial shaft fracture.
In this case. The crutches and fractured limb are third point. The crutches and In a three-point gait. Two-Point Gait In a two-point gait sometimes called hop-to gait. The crutches serve as one point. Each crutch and the crutches as the second unit Figure A non-weight-bearing fracture of the of the three points maintaining contact with the floor at femur used in a step-to gait pattern where the crutches any given time Figure Each crutch and weight-bearing limb is advanced sep- advanced as one unit and the uninvolved weight-bearing limb is arately.
Three-Point Gait the crutches and the fractured leg are one point and the uninvolved leg is the other point. This type of gait is not efficient. Point one is the crutch on the involved side. A partially weight-bearing femoral neck the uninvolved side Figures and A partially weight-bearing fracture with a secondary problem such as weakness.
In this instance.
The crutches and limbs are advanced separately. The fracture. The crutches are then brought up to the ing on the fractured extremity. To reduce or eliminate weight bear. The crutches are then brought up to the step. The crutches are heaven and the bad go down to hell. The stairs. The uninvolved extremity is then brought a step Figures To descend down to the step Figures If a banister is present and a patient is non- weight bearing. To descend stairs. Inman VT. The patient stands rehabilitation of patients in primary health care.
Statistical prediction of rehabilitation in elderly patients with hip fractures. Transfer chair. Braddom R.
Sullivan M. Finding meaning after the fall A pivot transfer is designed to keep the fractured injury: The patient does not pivot during transfer. This occurs with prefer using two crutches. Ambulatory Transfers Ceder L. Joint Structure and Function.
Ralston TR. Rehabilitation of fractures.. To perform a seated transfer. Seated Transfers Norkin C. During ambulatory transfers. Quirk M. They are used when neither lower Thorofare. Transfers the patient supports his or her body weight with the upper extremities. Acta on the uninvolved lower extremity and pivots with the Orthop Scand. Todd E Human Walking. Soc Sci Med.
Seated transfers do not require lower extremity Perry J. Brotzman SB. Hoppenfeld S. For the upper extremities. An upper extremity fracture. The patient is able to extend the reach. These devices extend reach without requiring the Instrumental ADL go beyond these fundamental patient to bend. In the early nating torque at the fracture site Figures and They are ping. A long-handled shoe horn. Because the disability after a frac.
For the lower extremi- ing. These devices serve to reduce but Figure This is particularly important in lower knobs. It extends reach to prevent stress on the joints and across the fracture site. Devices to Improve Safety Grab bars. Chair arms allow a patient to use upper extremity strength to reduce the force generated by the hip extensors across a proximal lower extremity fracture. A shower Building up the handles for various tools.
A hand-held shower may be useful if turning around or raising the arms produces stress at the fracture site. A too-soft seat cushion requires greater hip flexion to sit on because the body sinks into the surface.
The patient can slide into the and safety. This is most helpful for patients who are see later. A firm seat is helpful in cases of lower extremity or spinal fracture. After lower or standing. Grab bars are helpful to improve balance and safety when going from a sitting to an erect position in the bathroom.
This reduces the force generated by the gluteus maximus muscle. Canes come in various types. The amount of weight reduction adapted utensil may allow a person with a fractured depends on the type of device and the patient's train- upper extremity to grasp a plate. A cane unweights a fractured lower FIGURE Wide-based cane helps to reduce postfracture weight bearing on a lower extremity because the weight is trans- ferred through the cane to the upper extremity.
A leg lifter. Many assistive devices designed for spe. Thirty degrees of elbow flexion is necessary for push-off and weight bearing against the cane. Lofstrand in design. The If crutches are not used or sized appropriately.
When used correctly. The elbow is kept at 30 degrees of flexion to allow push-off and weight bearing on the upper extremity. Excessive force in the axilla must be avoided. The crutches is the rule Figure 7 Forearm crutches are top of the cane should reach approximately the level of used when open wounds or grafted skin on the arm the greater trochanter to allow the 30 degrees of elbow preclude the use of axillary crutches.
Crutches Crutches may be either axillary or forearm Canadian. Most of the weight is taken on the hand and forearm. The standard walkers and rolling walkers are used mostly by elderly patients who require more sta- bility to ambulate.
This makes walking on different sur- faces easier and makes it unnecessary to lift the walker to advance. The four legs of the walker are usually equipped with rubber caps or wheels rolling walkers. Walkers unweight a bearing by bearing weight through the upper extremi- ties and the walker Figure This is most frequently used with Reviews in Physical Medicine and Rehabilitation.
State of the Art borne by the forearm and elbow. Mechanism fracture patient who requires a large base of support Fracture Equipment of Action because of impaired balance or motor control. A walker should be considered for a post. Ceder L. This is Shoulder Grooming aids Extends reach frequently the case with elderly patients after hip or Reacher other lower extremity fractures.
These devices are and reach useful for patients with multiple fractures in which Sock-aid Extends reach weight bearing on one upper and one lower extremity Long-handled Extends reach is contraindicated.
Goldstein FC. Strasser DC. Functional outcome of cognitively impaired hip fracture patients on a geri- FIGURE Platform crutch is used when weight bearing at the atric rehabilitation unit. Woodard IL. Roberts VI. With a platform device. JAm Geriatr Soc. Once a fracture has achieved some stability with callus formation. This allows range of motion to the joints proxi- mal and distal to the fracture without compromising support at the fracture site see Figure FIGURE Hinged brace.
Once a fracture allowed. They may also be used to immobilize the has achieved some stability. This can be minimized lize and position one or several joints. Splints are used to immobi. Range of motion may be accomplished in and to prevent pain that occurs with motion.
A turnbuckle or dynamic brace is usually used after a fracture when there is a fixed joint contracture that is Thoracolumbosacral Orthoses not responding to stretch. Fractures of the humerus. A dynamic brace provides con. The Boston brace opens posteriorly and is able to overcome this constant stretch by active is customized to the individual patient. Individual ver- tebral bodies are immobilized in relation to each other. This type of brace is applied after the fracture is healed. An example may result in elbow or knee contractures.
The most confining type of thoracolumbosacral elbow. In this way. Both of these orthoses are used to increase jackets in general Figures and The iliac crest bumper prevents the brace stant stretch through a spring mechanism.
Treatment and Rehabilitation of Fractures. Description The ideal companion to Drs. Hoppenfeld and Murthy's acclaimed reference, "Treatment and Rehabilitation of Fractures", this superb CD-ROM provides one-click access to the full illustrations from the text. Because the CD-ROM uses a Power Point format, you'll find it easy and practical to adapt the many line illustrations for use in your own presentations, lectures, and courses.
It's also a great way for orthopaedists and physical therapists to review treatment options with patients! Rating details.