THIS PPT IS VERY USEFUL FOR PHYSIOTHERAPY STUDENTS

1. PHYSIOTHERAPY MANAGEMENT
FOR FOREARM FRACTURES
Prof. Dr. M. Rajesh, PT, M.P.T(cardio), B.C.R.C
TRINITY MISSION AND MEDICAL FOUNDATION
MADURAI

2. Orthopaedic goals
The forearm bones fracture should be treated with following
activity goals in mind
 Reduction should be perfect.
 Malunion is unacceptable.
 To restore the intraosseous space.
 Radial bow, length and rotation.
 To attain good stability at the fracture site.

3. Rehabilitation goals
 To restore back the joint movements and muscle strength
should be e the prime objectives after the rehabilitation
program of fore arm fractures.
 Movements - Emphasis is placed on restoring at least functional
if not full pronation / supination, wrist and hand function.

4. Functional goals
 It is important restore complete function of the fingers, elbow,
forearm supination and pronation requiring activities.

5. During Conservative Management
Barring a few specific exceptions like undisplaced ulnar
fracture and undisplaced fracture of both bones forearm and
Monteggia fractures in children's. Conservative management has
Limited role play in forearm bone fractures the methods of
conservative management include short arm cast for isolated
ulna fracture long arm cast both bone fracture, closed reduction
and above elbow cast for fracture in childrens e.g Montaggia.
Application program in this situation proceeds on the following
lines.
 Plaster – The plaster cast should be well padded snugly fitting
and should not immobilize the affected joints unnecessarily. The
Plaster should be inspected for cracks, soiling, loosening etc.

6.  Unaffected joints – the uninvolved and unaffected joints like
fingers and Shoulder should be kept in mobile by active, active
assistive and passive range of motion exercise.

8.  The involved joints - the elbow and wrist joints and forearm are
replaced only after 4 weeks, after removal of the plaster cast. Active
and active assistive and passive range of motion exercises are begun to
the elbow after removal of the plaster cast. however to restore back
the supination and pronation of the forearm.
 In the initial stages, patient is instructed to carry out the
supination, pronation actively with the forearm fully supported on
the thigh.
 This is followed by active assisted stretching of forearm by the
contralateral hand.
 Then passive stretching of the pronation/supination by the
unaffected hand is carried out.
 Finally as the patient gradually gains the moments full range
exercises using weights in the gradation is advocated

10. Surgical Management.
Post surgical rehabilitation after forearm fractures proceeds in
the following lines
 Plaster - There is no rule of long arm cast in forearm fractures
treated by open reduction and rigid internal fixation as the
fracture is quite stable. however a long arm cast is advised after
open reduction and internal fixation in the Galeazzi and
monteggia fracture. The care of plasters similar to the ones
mentioned in conservative methods.

11.  Unaffected joints - In Forearm fractures which are rigidly fixed
gentle active range of exercises are prescribed for joints of the
entire extremity including fingers wrist elbow and Shoulder. In
case of Montaggia and Galeazzi fracture active and passive
range of exercises are advised to the digits and Shoulder.
Isometric exercises are prescribed for the biceps, triceps and
deltoid muscles.

12.  The involved joints - Elbow and forearm mobilized in the first
week itself for forearm bone fractures which are fixed rigidly.
But for Monteggia and Galeazzi fracture. they are mobilise after
4 to 6 weeks and the rehabilitation program follows the same
pattern as for conservative treatments. After 8 to 12 weeks full
active and passive range of exercises for all the joints of the
extremity are begun. Resistive exercises using weights in
gradation are also begun. During the same period the affected
extremity can be used for self care and full weight-bearing can
also be allowed. During all the above methods of mobilizataion
for forearm supination-pronations, the patient is made to sit on
a stool with the elbow fixed to the sides and the forum resting
completely on the thigh.

13. Functional rehabilitation
 For 2 to 4 weeks the unaffected extremity is used for activities
of daily living. From 6 to 8 weeks onwards the patient make
permitted to use the affected extremity for self-care. Weight
bearing is allowed after 8 to 12 weeks.

14. THANK YOU
Prof. Dr. M. RAJESH, PT,M.P.T(cardio),B.C.R.C
TRINITY MISSIOIN AND MEDICAL FOUNDATION
MADURAI.
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