SKELETAL INJURIES

ANIEK P
BONE ANATOMY
 SKELETAL INJURIES
• A complete description should include the
mechanism of injury, anatomic location, line of
fracture & fragments
• As therapist, full knowledge of the characteristics
of a particular fracture is essential in planning a
treatment program, but the judgment ultimately
determines when the fracture is healed and what
primary methods of management are indicated
(when motion can be initiated)
 BONE HEALING / FRACTURE HEALING
• Bone healing or fracture healing is a
proliferative physiological process in which the
body facilitates the repair of bone fracture
BONE HEALING PHASE
• Three main stages of fracture healing :
– Inflamatory phase (10%)
– Reparative phase (40%)
– Remodeling phase (70%)
• These phase overlap
• The length of each phase varies depending on
the location and severity of the fracture,
associate injury and age patient
 VARIABLE INFLUENCES HEALING
ENHANCING
• Youth (Age)
• Early mobilization
• Adequete blood supply
• Nutrition (vit. A,C dan D,
mineral)
• Weight bearing exercise for
long bones (late stage)
• Adequate hormon (growth
hormon, calsitocin)
INHIBITING
• Type of fracture
• Bone loss due to severity of
fracture
• Inadequate immobilization
(motion at fracture site)
• Infection
• Avascular necrosis
Fracture healing rate
 General principles of treatment
• Focuses on obtaining an adequate reduction &
maintaining fracture stability while preventing
complications such as joint stiffness, tendon
adhesions, & edema formation.
• Structuring the rehabilitation process around the
phases of bone healing offers some guidelines
regarding the strength of the fracture site & its
ability to withstand various forms of treatment.
• The therapy program can be developed in 3
phases
• Phases I  prior to stability or clinical healing,
when joint motion may cause movement at the
fracture site
• Phases II  when the fracture is determined to
be stable (either through clinical healing or
surgical fixation) and can withstand at least active
joint motion
• Phases III  when the fracture is considered to
be healed or united and can withstand passive
joint motion and, finally, normal and resistive
hand use
 General treatment techniques
• Edema control
• Pain management
• Immobilization
• Restoring ROM
DISTAL RADIUS FRACTURE
 Colles fracture
• Treatment goal :
– Ortopedi
• Aligment to maintain radial length & palmar (volar)
• To allow for functional wrist mechanic
• Stability, pain free wrist for work and ADL
– Rehabilitation
• ROM
• Muscle strength
• Functional goal (power grip, pinch)
Methode of treatment : cast
Methode of treatment : external
fixation
Methode of treatment : ORIF (Open
Reduction Internal Fixation)
 TREATMENT GUIDE
• IMMEDIATE TO 1 WEEK
CAST EXT FIXATOR ORIF
STABILITY None None None

ORTHOPEDICS Trim to MCP prominance Evaluate pin site & Trim to MCP
dorsally to proximal tendon function prominance dorsally
palmar crease volary to proximal palmar
crease volary

REHABILITATION ROM shoulder & digits ROM shoulder, ROM shoulder,

elbow & digits elbow & digits
 • 2 WEEK
CAST EXT FIXATOR ORIF
STABILITY None to minimal None to minimal None to minimal

ORTHOPEDICS Trim to MCP Evaluate pin site & Remove suture &
prominance dorsally tendon function cast.
to proximal palmar Replace cast if
crease volary fixation is not rigid

REHABILITATION ROM shoulder & ROM shoulder, ROM shoulder,

digits elbow & digits elbow & digits.
Active ROM to wrist
if fixaton is rigid
• 4 TO 6 WEEKS
CAST EXT FIXATOR ORIF

STABILITY Stable Stable Stable

ORTHOPEDICS Shorten or remove Remove fixator at 6 Remove cast

cast, may still need to 8 weeks.
a night splint Replace with cast if
unstable

REHABILITATION Begin active ROM of Begin active ROM of Begin active ROM of
wrist if cast wrist if cast wrist if cast
removed removed removed
 • 6 to 8 WEEKS
CAST EXT FIXATOR ORIF
STABILITY Stable Stable Stable
ORTHOPEDICS Remove cast if not Remove fixator. Remove cast if not
already done Night splint for already done
comfort .
Cast applied if
fracture not healed

REHABILITATION Active & passive ROM to Active & passive Active & passive
wrist. ROM to wrist. ROM to wrist.
Gentle resistive exercise Gentle resistive Gentle resistive
to the wrist exercise to the wrist exercise to the wrist
• 8 to 12 weeks
CAST EXT FIXATOR ORIF
STABILITY Stable Stable Stable
ORTHOPEDICS Remove cast if not Remove fixator.
already done Night splint for
comfort .
Cast applied if
fracture not healed

REHABILITATION Active & passive ROM Active & passive Active & passive
and progressive ROM and ROM and
resistive exercise progressive progressive
resistive exercise resistive exercise
 CARPAL FRACTURE
• SCAPOID FRACTURE
Cast for scapoid fracture Scapoid splint
 Therapeutic Management of Carpal
Fracture
• Phase I
– ROM to all uninvolved joints of the upper extremity to
minimize stiffness & reduce edema
• Phase II
– When the fracture is stable enough for the cast to be
removed
– Focus : wrist, thumb & composite flexion
– Active assisted exercise can be added when the
patient’s AROM has reached a plateau & is pain free
– Static or dynamic splint often needed between
exercise session
• Phase III
– Fully healed
– Dynamic splint for wrist flexion and/or extension
or for composite flexion
– Grip strengthening should be initiated
immediately
– Wrist strengthening should follow once a pain-free
METACARPAL FRACTURE
Dynamic thumb flexion splint
MCP FLEXION SPLINT
PHALANX FRACTURES
EXTENSION FINGER SPLINT FLEXOR FINGER SPLINT
 CONTOH APLIKASI SPLINT
DYNAMIC PROX IP JOINT
EXT DIP JOINT EXTENSION
 DISLOCATION
• Is the temporary displacement of a bone from
its normal position in a joint
 Therapeutic management of
dislocations in the wrist
• Phase I
– Edema control & exercise to all distal and proximal joints
• Phase II
– Slowly to gently, using pain as a guide for aggressiveness
– The goal of treatment : regain maximum motion & strength
– A static wrist support is often necessary for comfort &
protection
• Phase III
– Exercise, passive motion
• Final phase
– Strengthening, include all muscles that cross the wrist, grip
strength
Dorsal blocking splint
THANK YOU