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Definition + Etiology
A disruption of the continuity of bone, usually caused by trauma. Direct violence, indirect violence, MM contraction, pathological #
- Simple/Closed: No external wound
- Compound/Open: Protruding through skin or into body cavity
- Complicated: Often infected
- Comminuted: Bone slintered into pieces
- Incomplete: Not entire diameter
- Impacted: Bones wedged into one another
- Greenstick: Bent+broken (kids)
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CIs and Precautions
- Hydro+ Casts
- Too, much too soon
- Fragile Tissue post-cast (jt mobes, frictions)
- Extreme Heat/Cold
- Hydro + Plates/pins (maybe)
- Confirm Unionization and consolidation
- ***Testing immobilized MM***
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S&S
- Shock
- P w/ Acute tenderness over Fx site
- MM spasm
- Loss of ARoM and/or PRoM
- Deformity
- Fatigue
-
H
- X-RAY EVIDENCE OF COMPLETE UNIONIZATION/CONSOLIDATION
- Type of Fx
- Other Tx
- Meds
- Immobilized Time/Device
- Plates/Pins/Screws
- Predisposing factors
- Smoking
-
O
- Edema, Girth
- Deformity
- Gait/Posture
- Post-cast:
- Pressure sores, cast dermitits
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P
- ***DO NOT CHALLENGE # SITE UNTIL MD/X-RAY CONFIRMED UNION***
- Bony deformity
- Size/location/shape of bone callus
- MM spasm TrP, HT
- Friable skin post-cast
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M
- ***Testing imoobilized MMs is CI'd***
- ARoM to prox+distal jts
- ***No weight bearing until MD OK***
- PRoM done with care, Pain-free
- ***No POP until MD OK***
- RRoM wait until unionization
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N
If NN damage suspected, test area/MM for motor/sensory
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R
- Sclerotomic
- Possible jt, visceral, deep fascial Pain
- TrP, MM spasm pain referral
- In chronic, fascial adhesions and plane of restriction referring pain
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S
- As per injury
- Homan's for DVT
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Tx Goals
- Initial Casting
- Decr comps
- pt edu
- Decr P and SNS firing
- Prevent swelling, MM spasm, atrophy, contractures
- Maintain RoM of all jts
- Post Casting
- Mobilize hypomobile jts
- Decr adhesions
- Increase venous return and tissue health
- Increase tissue extensibility
- Decr comps
- Maintain/increase RoM
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Tx
- Initial Casting
- Elevate limbs, support
- Vibrations and MLD-like techniques PROX
- PRoM to PROX+DIST jts for lymph drainage
- Tx associated injuries
- Post CastingFrictions
- Stretching
- Jt mobes
- Massage and PRoM
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Hydro
- Initial Casting
- Contrast to contralateral side
- Heat PROX to casting, pref on trunk
- Post CastingDMH if no edemaSkin brushing (start w/ cloth, progress to brush)
- Contrasts (mild at first)
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RemEx
- Initial CastingAerobic (eliptical/recumbant bike)
- Submax Iso Contractions
- Postural
- Post Casting
STR, graded return to function
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