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Any defect in the continuity of a bone
Fracture
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Three general categories of fractures:
Fracture by sudden impact (traumatic fracture) • Stress or fatigue fracture • Pathologic fracture
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the bone is out of alignment, the overlying soft tissue is not intact and the bone is exposed
Open displaced fracture
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Closed displaced fracture
the bone is out of alignment, but the overlying soft tissue is intact
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the bone has moved out of normal alignment (may require closed or open reduction)
Displaced fracture
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•Non-displaced fracture:
the bone has not moved out of normal alignment
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Stress fractures: the result of bone fatigue from repeated _______ stress to normal bon
abnormal
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Compressive stress fractures:
due to forceful compressive force to the bone (heel strike with running or marching)
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Distractive stress fractures:
due to the pull of muscle on a bony insertion point (can lead to avulsion, or tearing away of the bony insertion point)
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Pathologic fractures: occur in bone that is abnormally _______ due to another disease condition (cancer, reduced bone density)
fragile
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a subset of pathologic fractures; occur in bone that has structural alterations due to osteopenia, osteoporosis, or disorders of calcium metabolism
Insufficiency fractures
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One of the most common osteoporosis-related pathologic fractures
Vertebral Compression Fractures
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Vertebral Compression Fractures:
pathologic fractures occurring in the vertebrae of the spine
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Three classifications of Vertebral Compression Fractures
wedge, crush, or bi-concave depending on the appearance of the fracture • Wedge fractures are the most common
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Signs and Symptoms of Fractures
Pain and tenderness • Increased pain with weight bearing • Edema • Ecchymosis • Loss of general function and mobility • Deformity (may not always see especially in certain fractures
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Hematoma formation (48-72 hours after fracture) • Cellular proliferation • Callous formation • Ossification • Consolidation/remodeling
Fracture Healing Sequence
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Healing time for fractures
Children: 4-6 weeks • Adolescents: 6-8 weeks • Adults: 10-18 weeks
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Colles Fracture
Fracture of distal radius and ulnar styloid (Fall on outstretched hand)
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Fracture of the base of the 5th metatarsal
Jones Fracture
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Nightstick Fracture:
Fracture of mid-shaft of ulna
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Oblique fracture of lateral malleolus and a transverse fracture of the medial malleolus. Talus may be displaced posteriorly
Pott’s Fracture
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Fracture healing time is normal, but the bony alignment is abnormal, resulting in deformity
Malunion
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Delayed union:
the fracture heals in good alignment, but takes much longer than expected
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Non-union: ________ of the fracture to heal
failure
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when fat globules from the bone marrow or surrounding soft tissues migrate to the lungs and block pulmonary vessels
Fat embolism: potentially FATAL. Most often occurs after fractures of the long bones
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significant swelling around the fracture site within a closed soft tissue compartment
Compartment syndrome
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Significant swelling around fracture site but if contained within closed soft tissue compartment, compartment syndrome may occur.
Compartment Syndrome
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Symptoms include pain, decreased motor function, burning, paresthesia, decreased reflexes
Compartment Syndrome
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Can end up causing a surgical site to rupture
Compartment Syndrome
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Types of Immobilization
Bed rest • Casting • Splinting/bracing • Non-weight bearing status • Disuse secondary to pain
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Adherence of fibrofatty connective tissue to cartilage surfaces • Loss of cartilage thickness • Pressure necrosis at area of compressed cartilag
Cartilage Response to Immobilization
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Synovium Response to Immobilization
Proliferation of fibrofatty connective tissue into joint space
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Bone response to immobilization
Generalized osteoporosis
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Ligament response to immobilization
Disorganization of parallel arrays of fibrils and cells • Weakening and destruction of ligament fibers where they attach to the bone
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Muscle response to immobilization
Disorganization of parallel arrays of fibrils and cells; weakening; possible loss of sarcomeres
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Cartilage response to immobilization
Adherence of fibrofatty connective tissue to cartilage surfaces • Loss of cartilage thickness • Pressure necrosis at area of compressed cartilage
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Important to maintain function of all other areas while body part is immobilized • Effects of immobilization are reversible • Consider impact of immobilization on all tissue types and address in the rehabilitation program
Implications for tissue response to immobilization for PT Intervention
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Complete loss of joint integrity with loss of anatomical relationship
Dislocation
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Most common at gleno-humeral joint and congenitally at the hip
Dislocation
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Partial disruption of anatomic relationship within a joint • Most commonly seen at mobile joints
Subluxation
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For dislocations and subluxations: • Address local muscle imbalances such as strength/weakness imbalances and length/flexibility imbalances • Work muscles that stabilize involved joints
Implications for PT Intervention
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Direct trauma • Overlying skin intact but underlying tissue becomes ecchymotic (bruised) due to local hemorrhages
Contusions
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Areas of localized hemorrhage • Blood accumulates due to rupture of capillaries
Hematomas
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Stretching or tearing of the musculotendinous unit
Strain
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Ligament injury from abnormal or excessive joint motion
Sprain
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Severity of tissue tearing • 1st Degree:
Injury of few fibers without loss of ligament integrity
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Severity of tissue tearing • 2nd Degree:
Moderate tearing of fibers and hematoma
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Severe tearing, rupture, marked swelling
3rd degree tissue tearing
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4th Degree tissue tearing
Severe tearing, rupture with avulsion fracture
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