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Rehabilitasi AGA AGB
Rehabilitasi AGA AGB
4-6 Advance isometric exercises Continue with passive-assistive Continue with passive-assistive
ROM ROM
Rehabilitation Fraktur Humerus Proximal
Weeks Nonoperative Fixation Operative Fixation Endoprosthesis
6-8 Begin active ROM with Begin active ROM with terminal • Begin active ROM shoulder,
terminal stretching, stretching, emphasizing elevation emphasizing elevation and external
emphasizing elevation and and external rotation rotation
external rotation • Advance isometric shoulder
exercises in all planes
8-12 Begin resistive shoulder Begin resistive shoulder exercises Begin resistive shoulder
exercises and continue and continue terminal capsular exercises and continue terminal
terminal capsular stretching stretching capsular stretching
>12 • Continue resistive exercises • Continue resistive exercises with • Continue resistive exercises
with increasing resistance increasing resistance • Continue capsular stretching
• Continue capsular stretching • Continue capsular stretching
Fraktur Midshaft Humerus
• Bagian diafisis humerus • Rehabilitation Goals
1. Mengembalikan ROM bahu dan
siku
2. Meningkatkan kekuatan
m.pectoralis major, deltoid,
biceps, dan triceps
3. Fungsional: Meningkatkan atau
mengembalikan fungsi bahu
untuk ADL.
• Bone healing: 8 – 12 minggu
• Rehabilitasi: 12 minggu – 16 minggu
Rehabilitasi Fraktur Midshaft Humerus
Weeks Cast Rod Plate
0-1 • Move digits to diminish hand If stable fixation, the patient may • If stable fixation, the patient may
swelling begin moving the shoulder and range the shoulder and elbow as
• No strengthening or ranging to elbow as pain allows pain allows
elbow or shoulder • If unstable, no ROM
2-4 • Begin gentle ROM to elbow • Progress with ROM to shoulder • Progress with ROM to shoulder
and shoulder and elbow and elbow
• No strengthening • Pendulum exercises to the • Pendulum exercises to the
shoulder shoulder
• Limited weight bearing is allowed • No weight bearing
4-6 • Aggresive ROM to shoulder and • If callus is evident, weight bearing • Lightweight bearing allowed
elbow is to be progressed • Aggresive ranging and light
• Strengtehning with isometric and • Isotonic and isometric strengthening to shoulder and
isotonic exercise
strengthening, and ranging to elbow
• Light weight bearing to
extremity elbow and shoulder
• Use extremity for ADL
8-12 Full weight bearing, ranging, Full activities Full activities
andprogressive resistive
exercises for strengthening
Fraktur Humerus Distal
• distal humerus melibatkan • Rehabilitation goals:
metafisis, bisa sampai ke 1. Mengembalikan full ROM elbow dan
shoulder, melindungi sudut normal
permukaan intraartikuler carrying dari elbow.
2. Meningkatkan kekuatan dari otot-
otot: triceps, biceps, forearm
supinators & pronators, wrist
extensors, wrist flexors, dan deltoid
3. Mengembalikan aktivitas yang
membutuhkan fleksi/ekstensi dan
pronasi/supinasi, misalnya makan,
pesrsonal hygiene, dressing, dan
grooming.
• Bone healing: 8 – 12 minggu
• Rehabilitasi: 12 – 24 minggu
Rehabilitation Fraktur Humerus Distal
Weeks Cast/Splint Percutaneous Pinning ORIF
0-1 • Active ROM exercises to the • Active & passive ROM exercises to the • Assuming a stable construct, begin
digits digits gentle active ROM exercises to the
• Active & Active-assistive ROM • Active & Active-assistive ROM exercises to entire extremity, including elbow,
the shoulder fingers, wrist, and shoulder within 3 to 5
exercises to the shoulder
• Isometric exercises to biceps, triceps, & days as soft tissues allow
• Avoid elbow motion deltoid • Avoid passive ROM exercises to the
• No shoulder internal/external • Avoid elbow motion elbow to reduce the risk of myositis
rotation exercises • No shoulder internal/external rotation ossificans
exercises
2-4 • AROM exercises to the digits • Active & passive ROM exercises to the • Continue gentle active ROM
• AROM & AAROM exercises shoulder digits exercises to the entire extremity,
• Isometric exercises to biceps, triceps,
deltoid, and forearm muscles • Active & Active-assistive ROM including elbow, wrist, fingers, and
• Begin grip strengthening exercises with exercises to the shoulder shoulder
ball or putty • Isometric exercises to biceps, triceps, • Begin grip strengthening exercises
• No pronation/supination or shoulder deltoid, & forearm muscles with ball or putty
internal/external rotation exercises
• For extension type supracondylar • Begin grip strengthening exercises • Avoid passive ROM exercises to
humerus fractures, may add supervised with ball or putty the elbow to reduce the risk of
elbow flexion from 90° up with posterior • No pronation/supination or shoulder myositis ossificans
splint immobilization between sessions internal/external rotation exercises
Rehabilitation Fraktur Humerus Distal
Weeks Cast/Splint Percutaneous Pinning ORIF
4-6 • Once clinical stability and radiographic • Once clinical stability and radiographic • Continue active & active-assistive
healing are present, begin supervised healing are present, begin supervised active ROM exercises to the entire extrimity
active elbow ROM. Usually a home elbow ROM. Usually a home program may be including elbow, wrist, fingers, and
program may be added by 6 weeks. added by 6 weeks. Between sessions the
Between sessions the patient should be patient should be protected
shoulder
protected • Continue grip strengthening exercises with • Continue grip strengthening
• Continue grip strengthening exercises ball or putty exercises with ball or putty
with ball or putty • Avoid passive ROM exercises to the elbow to • Avoid passive ROM exercises to the
• Avoid passive ROM exercises to the reduce the risk of myositis ossificans elbow to reduce the risk of myositis
elbow to reduce the risk of myositis ossificans
ossificans
8-12 • Continue active and add passive ROM • Continue active and add passive ROM to all • Continue active and add passive ROM to
to all joints of the extremity while joints of the extremity while focusing on all joints of the extremity while focusing
focusing on flexion/extension of the flexion/extension of the elbow and on flexion/extension of the elbow and
elbow and pronation/supination of the pronation/supination of the forearm pronation/supination of the forearm
forearm • Continue grip strengthening exercises with • Continue grip strengthening exercises with
• Continue grip strengthening exercises ball or putty ball or putty
with ball or putty • Introduce resistive exercises using weights in • Introduce resistive exercises using weights
• Introduce resistive exercises using gradation, starting with 1 to 2 punds in gradation, starting with 1 to 2 punds
weights in gradation, starting with 1 to • The risk of myositis ossificans related to • The risk of myositis ossificans related to
2 punds passive ROM of the elbow has significantly passive ROM of the elbow has significantly
• The risk of myositis ossificans related to decreased decreased
passive ROM of the elbow has
significantly decreased
Fraktur Forearm
• Definisi:
Fraktur yang terjadi pada
shaft dari radius, ulna, atau
keduanya.
Monteggia: dislokasi caput
radius akibat fraktur ulna
Galeazzi: dislokasi sendi
radioulnar distal akibat
fraktur radius
Rehabilitation Fraktur Forearm
Weeks Cast ORIF of Both Bone Fractures ORIF of Galeazzi & Monteggia
Fractures
0-1 •Long arm cast AROM & No cast with stable fixation: gentle • Long arm cast: active and passive
PROM shoulder active ROM exercises for the entire ROM exercises to the digits.
•Short arm cast AROM & extremity, including fingers, wrist, • Active & active assistive ROM
exercises to the shoulder
PROM digits; AROM & elbow, and shoulder Isometric exercises to the biceps,
•
AAROM elbow and shoulder triceps, & deltoid
2 •Long arm cast AROM & No cast with stable fixation: gentle • Long arm cast: active and
PROM digits; AROM & active ROM exercises for the entire passive ROM exercises to the
AAROM shoulder extremity, including fingers, wrist, digits.
•Short arm cast AROM & elbow, and shoulder • Active & active assistive ROM
PROIM digits; AROM & exercises to the shoulder
AAROM elbow and shoulder • Isometric exercises to the
biceps, triceps, & deltoid
Rehabilitation Fraktur Forearm
Weeks Cast ORIF of Both Bone Fractures ORIF of Galeazzi & Monteggia
Fractures
4-6 • short arm cast: AROM & PROM digits; • No cast with stable fixation: gentle • Long arm cast: active and
AROm & AAROM shoulder; gentle active ROM exercises for the entire passive ROM exercises to the
AROM elbow in all planes,; ball extremity, including fingers, wrist,
squeezing exercises; isometrics digits.
elbow, and shoulder
exercises to biceps, triceps, and
• At 6 weeks, gentle active resistive • Active & active assistive ROM
deltoid exercises to the shoulder
• When casting of isolated ulnar exercises can be started
fracture discontinued: gentle AROM • No lifting or weight bearing allowed, • Isometric exercises to the
fingers, wrist, elbow, & shoulder; although patient may use extremity to biceps, triceps, & deltoid
gentle resistive exercises can be eat or write
started
8-12 • When immobilization discontinued: • When immobilization discontinued: full • When immobilization discontinued: full
full active and passive ROM exercises active and passive ROM exercises to all active and passive ROM exercises to all
to all joints of the extremity while joints of the extremity while focusing on joints of the extremity while focusing on
focusing on pronation and supination pronation and supination of the forearm pronation and supination of the forearm
of the forearm • Putty and ball squeezing exercises improve • Putty and ball squeezing exercises
• Putty and ball squeezing exercises grip strength improve grip strength
improve grip strength • Introduce resistive exercises using weights • Introduce resistive exercises using
• Introduce resistive exercises using in gradation weights in gradation
weights in gradation
Fraktur Colles
Rehabilitation goals:
• Definisi: • Mengembalikan full ROM dari wrist dan
fingers
Fraktur distal metaphyseal • Memperbaiki kekuatan otot-otot
radius, disertai dengan angulasi hipotenar dan tenar, lumbrical, interossei.
volar dari apex fraktur (silver • Memperbaiki kekuatan otot-otot yang
fork deformity), displacement melalui wrist: extensor digits, flexor digits,
ke arah dorsal dari fragmen abductor pollicis longus, flexor carpi
distal, dan pemendekan radius. radialis, flexor carpi radialis, extensor carpi
radialis longus & brevis, extensor carpi
ulnaris.
• Functional goals: mengembalikan
kekuatan grip, grasp, dan pincer grip.
Rehabilitation Fraktur Colles
Weeks Cast ORIF of Both Bone Fractures ORIF of Galeazzi & Monteggia
Fractures
0-1 ROM of shoulder and digits ROM of shoulder, elbow, and digits ROM of shoulder, elbow, and digits
2 ROM of shoulder and digits ROM of shoulder, elbow, and digits • ROM of shoulder, elbow, and
digits
• Active ROM to the wrist if fixation
is rigid
4-6 Begin active ROM of wrist if Begin active ROM of wrist if cast Begin active ROM of wrist if cast
cast removed removed removed
6-8 • Active & passive ROM to • Active & passive ROM to wrist as • Active & passive ROM to wrist
wrist tolerated • Gentle resistive exercises to the
• Gentle resistive exercises to • Gentle resistive exercises to the wrist
the wrist wrist
8-12 Active & passive ROM and Active & passive ROM and Active & passive ROM and
progressive resistive progressive resistive exercises progressive resistive exercises
exercises
Rehabilitasi Fraktur AGB
Fraktur Femur
• Fraktur neck femur
• Fraktur shaft femur
Fraktur Neck Femur
proximal dari garis Rehabilitation goals:
• Memperbaiki ROM lutut dan hip
intertrochanter di dalam daerah • Memperbaiki kekuatan otot-otot:
interkapsular dari hip Gluteus medius
Iliopsoas
Gluteus maximus
Adductor magnus, longus, dan brevis
Quadriceps
Hamstrings
• Fungsional: menormalkan pola gait pasien, fleksi
hip 90° untuk posisi duduk yang baik
• Bone healing: 12 – 16 minggu
• Rehabilitasi: 15 – 30 minggu
Rehabilitasi Fraktur Neck Femur
Internal Fixation Hemiarthroplasty
ROM
• AROM exc Minggu ke-1
• AAROM exc Minggu ke-2
• PROM exc Minggu ke-4
Strengthening
• Isometric exc Minggu ke-1
• Isotonic exc Minggu ke-4
Weight Bearing
• Partial WB Minggu ke-
• Full WB Minggu ke-12
Fraktur Shaft Tibia Rehabilitation goals:
• Memperbaiki ROM lutut dan ankle
Definisi: Fraktur diafise tibia yang • Memperbaiki kekuatan otot-otot:
biasanya tidak melibatkan daerah Dorsiflexors: tibialis anterior, extensor
artikuler atau metafise hallucis longus, extensor digitorum
longus
Plantarflexors: gastrocnemius, soleus,
flexor digitorum, flexor hallucis longus
Inverters: tibialis posterior, tibialis
anterior
Everters: peroneus longus & brevis
• Fungsional: menormalkan pola gait pasien
• Bone healing: 10 – 12 minggu
• Rehabilitasi: 12 – 24 minggu
Rehabilitasi Fraktur Shaft Tibia
Cast ORIF External Fixation
ROM
• AROM exc Minggu ke-1 Minggu ke-1 Minggu ke-1
• AAROM exc Minggu ke-8 Minggu ke-8 Minggu ke-8
• PROM exc Minggu ke-8 Minggu ke-8 Minggu ke-8
Strengthening
• Isometric exc Minggu ke-1 Minggu ke-1 Minggu ke-1
• Isotonic exc Minggu ke-4 Minggu ke-4 Minggu ke-4
Weight Bearing
• Partial WB Minggu ke- Minggu ke-1 Minggu ke-1
• Full WB Minggu ke-12 Minggu ke-8 Minggu ke-8
(~ toleransi)
Fraktur Ankle Rehabilitation goals:
• Memperbaiki ROM ankle pada semua arah
• Definisi: Fraktur ankle meliputi • Memperbaiki kekuatan otot-otot:
fraktur dari maleolus lateral dan Plantar fleksor ankle & foot: gastrocnemius,
medial, juga permukaan artikuler soleus, tibialis posterior, flexor digitorum
longus, flexor hallucis longus
dari tibia dan fibula
Dorsifleksor ankle & foot : tibialis anterior,
extensor digitorum longus, extensor
hallucis longus
Evertor foot: Peroneus longus, peroneus
brevis
Invertor foot: tibialis posterior, tibialis
anterior
• Fungsional: menormalkan pola gait pasien
• Bone healing:
Extraarticular (isolated lateral malleolar): 6 – 10
minggu
Intraarticular (bimalleolar, trimalleolar, bimalleolar
equivalent, medial malleolar): 8 – 12 minggu
• Rehabilitasi:
Extraarticular malleolar: 12 – 16 minggu
Intraarticular malleolar: 16 – 24 minggu
Rehabilitasi Fraktur Ankle
Cast ORIF
ROM
• AROM exc Minggu ke-1 Minggu ke-1
• AAROM exc Minggu ke-8 Minggu ke-8
• PROM exc Minggu ke-8 Minggu ke-8
Strengthening
• Isometric exc Minggu ke-2 Minggu ke-2
• Isotonic exc Minggu ke-6 Minggu ke-6
Weight Bearing
• Partial WB Minggu ke-4 (~toleransi) Minggu ke-4 (~toleransi)
• Full WB Minggu ke-8 (~ toleransi) Minggu ke-6
Terima Kasih
Komplikasi Fraktur
• Komplikasi dini
• Komplikasi lanjut
Komplikasi Dini
Lokal Jauh
• Kulit : nekrosis, trombosis vena • Emboli lemak
• Sendi : infeksi • Emboli paru
• Tulang : osteomyelitis, nekrosis • tetanus
avaskular
Komplikasi lanjut
Lokal Jauh
• Sendi : kaku, degenerasi sendi • Renal kalkuli
• Tulang:
malunion, delayed union, non
union, gangguan pertumbuhan
• Otot : posttraumatic myositis
ossificans
Myositis Ossificans
• extra-skeletal ossification that
occurs in muscles & other soft
tissues
• As a result of impact which
causes damage to the sheath
that surrounds a bone
(periosteum) as well as to the
muscle
• 80% ossifications arise in the
thigh or arm
• Other sites include intercostal
spaces,erector spinae ,pectoralis
muscles, glutei, and the chest
Cause
• Not applying cold therapy and compression immediately after the
injury.
• Having intensive physiotherapy or massage too soon after the injury.
• Returning too soon to training after exercise.
Symptom
• Restricted range of movement
• Pain in the muscle when it is used
• A hard lump in the muscle
• An X-ray can show bone growth
X-ray CT Scan
• soft tissue ossification not • calcification of the heterotopic
attached to bone is common ossification proceeds from the
• x-rays show round mass w/ outer margin and progresses
distinct peripheral margin of centrally
mature ossification & a
radiolucent center of immature Bone Scan
osteoid & primitive
• active myositis appears as
mesenchymal tissue
intense para-osseous
• this peripheral maturation, accumulation of tracer activity in
reverse of that seen in a acutely damaged muscle on
malignant tumor, is delayed images;
characteristic of myositis
Treatment
• Rest
• Immobilization
• Anti-inflammatory drugs
• physiotherapy management
• surgical debridement
Physiotherapy management
• Rest
• Immobilization
• pulsed Ultra sound and phonophoresis
• Maintain available range of motion but avoid stretching and massage,
until maturation.
• iontophoresis with 2 % acetic acid solution.
• extra corporeal shock wave therapy
Surgical treatment
• Growth should not be removed in premature stage as it will likely
reoccur.
• The ossification becomes exuberant, infiltrates beyond the original
site, and compresses the soft tissues around beyond hope of repair.
• When after serial x-rays the mass is dense, well delineated, and at a
stand still, it may be safely removed.
• It may be possible to prevent myositis by aspirating the original
haematoma.
TERIMA KASIH