2. Fracture
“Structural break in the continuity of a bone, epiphyseal plate, or cartilaginous joint surfaces is called
a fracture”.
Serious Soft tissue injury → major artery or peripheral nerve involved.
Central fracture → Brain, Spinal cord, Viscera involved.
Position of Fracture Fragments (Distal w.r.t Proximal segment)
Nondisplaced
Medial displaced
Lateral displaced
Distracted
Over-riding with posterior & superior displacement
Distracted & laterally rotated
Direction of Fracture w.r.t Longitudinal Axis
Tranverse
Longitudinal
Oblique
Spiral
Frequently occurring Comminuted Fracture patterns:
Wedge-shaped or Butterfly pattern
Two or Three-segmental level fracture
Fracture with multiple fragments
Classification of Fractures
Site → Diphyseal, Metaphyseal, Epiphyseal, Intra-articular
Extent → Complete, Incomplete
Configuration → Transverse, Oblique or Spiral, Comminuted
Relationship of Fragments → Undisplaced, Displaced
Relationship to Environment → Closed, Open
Complications → Local or System →Related to Injury or Treatment
Classification on the basis of the Forces acting
Bending (Angulatory) → Transverse or Oblique Fracture, Greenstick Fracture (Children)
3. Twisting (Torsional) → Spiral Fracture
Straight pulling (Traction) → Avulsion Fracture
Crushing (Compression) → Compression Fracture, Torus (Buckle) Fracture in Children
Repetitive microtrauma → Fatigue or Stress Fracture
Abnormal bone → Pathological Fracture
MANAGEMENT GUIDELINES (Period of Immobilization)
Plane of Care
1. Educate the patient
2. ↓ the effects of Inflammation in Acute period
3. ↓ the effects of Immobilization
4. Bedridden patient → maintain Strength & ROM in major muscle groups
Intervension
1. Teach functional adaptations; Teach safe ambulation, bed mobility
2. Ice, Elevation
3. Intermittent muscle setting; Active ROM (above or below the immobilized region)
4. Resistance exercises to major muscle groups not immobilized (preparation for future
ambulation)
MANAGEMENT GUIDELINES (Postfracture/Postimmobilization)
Plane of Care
1. Educate the patient
2. Provide protection until radiologically healed
3. Initial active exercises
4. ↑ Joint & soft tissue mobility
5. ↑strength & muscle endurance
6. Improve cardiopulmonary fitness
Intervension
1. Inform patient of limitations until fracture site is radiologically healed.
Teach home exercises that reinforce interventions.
2. Use partial weight-bearing in lower limbs & nonstressful activities in the upper limbs.
3. Active ROM, gentle multiangle isometrics.
4. Initiate joint play stretching techniques (III-IV) with force applied proximal to
healing fracture site.
Apply force proximal to healing fracture site until radiologically healed.
4. 5. As ROM increases & bone heals → Initiate resistive & repetitive exercise
6. Initiate safe aerobic exercises which don’t stress fracture site until it is healed.
