i bc27f85be50b71b1 (72 page)

Table 3-A.1. Young Classification, Management, and Physical Therapy Intervention for Pelvic Ring Fractures

N

'"

00

Fracture Type

Management Options

Physical Therapy Interventioll

§

APC, type I�isruption of the pubic

Symptomatic pain managemenc

Functional mobility PWB or WBAT as

symphysis with <2.5 em of diastasis;

tolerated

�

j:;

no significant posterior pelvic injury

Hip and disca) joint NAAROM

:r

>

APC, type ll�isruption of the pubic

External fixation

Functional mobility NWB, -(DWB, or

z

"

symphysis of >2.5 cm with tearing of

Anterior ORIF

PWB

g

the anterior sacroiliac, sacrospinous,

Hip and disca) joint ANAROM

'"

and sacrotuberous ligaments

Lower-extremity exercise

o

"

APC, type III--complete disruption of

External fixation

Functional mobility NWB or rOWB

�

the pubic symphysis and posterior

Posterior percutaneous pinning

(usually limited to transfer out of bed

�

ligament complexes, with hcmipelvic

only) on the least-involved ,ide

�

..-

displacement

Anterior and posterior ORIF

Distal lower-extremity AJAAFOM

�

LC, type I-posterior compression of

Sympromatic pain management

See APC, type I, above

�

the SIj without ligamenc disruption;

�

oblique pubic ramus fracture

�

le, type lI-rupture of the posterior

External fixation

See APC, type III, above

sacroiliac ligament; pivotal internal

Anterior and posterior ORIF

roration of the hemipelvis on the SIJ

with a crush injury of the sacrum

and an oblique pubic ramus fracture

LC, type lII-findings in type 11 with

Anterior and posterior ORlF

See APe, eype III, above

evidence of an APC injury to the

contralateral pelvis

Vertical shear--complete ligament or

Traction if not medically cleared for

See APC, type III, above

bony disruption of a hemipelvis assosurgery

Positioning, breathing exercise, and uninciated wim hemipelvic displacemenr

Percutaneous fixation (SIJ)

volved extremiry exercise if on bed rest

External fixation

Anterior and posterior ORIF

AlAAROM = acrive/ac[ive-3ssistive range of motion; APC = anteroposterior compression; LC = lateral compression; PWB = panisl weight bearing; NWB = non weight bearing; ORIF = open-reduction imernal fixation; 511 = sacroiliac joint; mWB = touch-down weight bearing; WBAT = weighr bearing as tolerated.

�

Sources: Adapted from HG Cryer, EJohnson. Pelvic Fracrures.In DV Feliciano, EE Moore, KL Marrox (eds), Trauma (3rd ed). Stamford, CT:

�

Appleton & Lange, 1996;640; and data from AR Burgess, AL Jones. Fractures of the Pelvic Ring. In CA Rockwood, DP Green, RW Bucholz, p

JD Heckman (cds), Rockwood and Green's Fracrures in Adults (4th ed), Philadelphia: Lippincon-Ravcn, 1996.

�

1:;

r-

�

r-

� �

�

x

w

,.

N

w

'"

Table 3-A.2. Management and Physical Therapy Intervention for Acetabular Fractures·

'"

....

o

Fracture Type

Management Options

Physical Therapy Imervention

>

()

Stable (displacement of <2-5 mm in the

Traction with bed rest

Functional mobility TDWB or PWB

�

dome with an imacr weight bearing sur

Closed reduction

Gende ROM exercise

�

face) (e.g., distal anterior column, djstal

;;

transverse, or bom-column fracrure with

Positioning, breathing exercise, and uniniE

out major posterior column displacement)

volved extremity exercise if on bed rest

�

Continuous passive motion at knee for

8

indirect hip ROM

'"

Unstable (any fracture with a non Intact

Percutaneous pinning

Functional mobility PWB or weight bearo

weight-bearing dome) (e.g

"

.• large ante

Open reduction internal fixation

ing as tolerated

�

rior, large posterior, superior transverse,

J:

(may involve trochanteric osteot

Gentle hip ROM

�

or T-shaped fracture)

omy if posterior wall fracture)

Hip precautions per physician for total hip

�

Total hip arthroplasty

arthroplasty

:;I

PWB = partial weIght beanng; ROM = range of motion; TOWB = touch-down weight bearing.

�

·The patient m3y have hip dislocation precautions if the acetabular fracture IS associated with hip dIslocation.

Sources: Data from TG DIPasquale, RJ NOWinSki. The Acute Care and Evaluation of Acctabubr Fractures. In M Bosse, JF Kellam, TJ Fisher, P

�

Tomena (cds), Orthopaedic Knowledge Update: Trauma (2nd ed). Rosemont,IL: American Academy of Orthopaedic Surgeons. 2000; and M

Tile. Fractures of the Acetabulum. In CA Rockwood. Dr Green. RW Bucholz, JD Heckman (cds), Rockwood and Green's Fractures in Adults (4th cd). Philadelphia: Lippincott-Raven, 1996.

�IUSCULOSKELETAL SYSTEM APPENDIX )-A

24 t

Table 3-A.3. Garden Classification, Management, and Physical Therapy

Inrervention for Inrracapsular Hip Fractures

Managemenr

Fracrure Type

Options

Physical Therapy Intervention

Garden I (impacted,

Closed reduction

Functional mobiliry P\'Q'B

incomplete

and percutaneor NWB (spica)

fracture)

ous pinning

NAAROM exercises

Closed reduction

(Iimired by pain)

and spica casr

Lower-extremity strengthening

Garden II (complete

Closed reduction,

Functional mobility PWB

fracture witheur

internal pin

N A A ROM exercises

displacement)b

fixation

(Iimired by pain)

ORIF

Lower-extremity strengthening

Garden III (complere

ORIF

See Garden II, above

fracture with parrial displacement,

capsule partially

inract)

Garden IV (complete

ORIF

Functional mobility PWB

fracture with full

Unipolar or bipolar

or WBAT, NAAROM

displacement and

arthroplasty

exercises and strengthening,

capsule disruption)

usuall y with posterior hip

precaurions

NAAROM = active/active-assisted range of motion; NWB = non weight bearing; ORIF