GenO OP-Fractures

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)

• 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***

• Shock
• P w/ Acute tenderness over Fx site
• MM spasm
• Loss of ARoM and/or PRoM
• Deformity
• Fatigue

• X-RAY EVIDENCE OF COMPLETE UNIONIZATION/CONSOLIDATION
• Type of Fx
• Other Tx
• Meds
• Immobilized Time/Device
• Plates/Pins/Screws
• Predisposing factors
• Smoking

• Edema, Girth
• Deformity
• Gait/Posture

• Post-cast:
• Pressure sores, cast dermitits

• ***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

• ***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

If NN damage suspected, test area/MM for motor/sensory

• Sclerotomic
• Possible jt, visceral, deep fascial Pain
• TrP, MM spasm pain referral
• In chronic, fascial adhesions and plane of restriction referring pain

• As per injury
• Homan's for DVT

• 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

• Initial Casting
• Elevate limbs, support
• Vibrations and MLD-like techniques PROX
• PRoM to PROX+DIST jts for lymph drainage
• Tx associated injuries

• Post Casting
• Frictions
• Stretching
• Jt mobes
• Massage and PRoM

• Initial Casting
• Contrast to contralateral side
• Heat PROX to casting, pref on trunk

• Post Casting
• DMH if no edema
• Skin brushing (start w/ cloth, progress to brush)
• Contrasts (mild at first)

• Initial Casting
• Aerobic (eliptical/recumbant bike)
• Submax Iso Contractions
• Postural
• Post Casting
• STR, graded return to function