i bc27f85be50b71b1 (74 page)

motion; TDWS = touch-down weight bearing.

Source: Data from AI> Whittle. Fractures of the Lower Extremity. In ST Canale (ed),

Campbell's Operative Orrhopaedics. Vol. 3 (3rd ed). St. Louis: Mosby, 1998.

Table 3-A.7. Managemenr and Physical Therapy Intervention for

Patellar Fractures

Physical Therapy

Fracture Type

Management Options

Intervention

Nondisplaced

Closed reduction

Functional mobility

Long leg cast (or other

PWBor WBAT

immobilization

Avoid strong straight

brace) with full knee

leg raise and strong

extension

quadriceps contrac-

tion because it can

stress the fracture

site

Displaced (simple

ORIF with immobiliza-

See Nondisplaced, above

vertical or trnns-

rion of rhe knee at

AAROM (per physician)

verse fracture)

full extension

after few days of

Continuous passive

immobilization

Illorion

Comminuted

ORIF (with fragment

Functional mobility NWB,

removal, if applicable)

PWB, or WBAT

246 ACUTE CARE HANDBOOK FOR PHYSICAL THERAI%TS

Table 3-A.7. Continued

Physical Therapy

Fracture Type

Management Options

Intervention

Partial patellectomy

See Nondisplaced,

(when one large fragabove, in regard to

menr remains) or

quadriceps

total patellectomy (if

no large fragments

remain) and quadriceps tendon repair

Immobilization with

long leg cast, long leg

brace, or posterior

splint at full k nee

extension or slight

flexion

AAROM = active-assisted range of motion; ORIF = open-reduction internal fixation;

NWB = non weight bearing; PWB = parrial weight bearing; WBAT = weight bearing as

tolerated.

Source: Data from AP Whittle. Fractures of Lower Extremity. In ST Canale (ed.) Camp·

bell's Operative On:hopaedics, Vol. 3 (9th ed). Sr. Louis: Mosby, 1998.

Table 3-A.S. Management and Physical Therapy Intervention

for Tibial Plateau Fractures

Physical Therapy

Fracture Type

Management Options

Intervention

Nondisplaced

Closed reduction

Functional mobility

Cast-brace immobilization

TDWB or PWB

or postoperative knee

AAROM exercise,

brace

continuous passive

Ligament repair (if applimorion to knee joint,

cable)

or both

MUSCULOSKELETAL SYSTEM APPENDIX J-A

247

Physical Therapy

Fracture Type

Management Options

Imervention

Displaced; single

External fixation

Functional mobiliry

condylar or

ORIF

NWB ,mWB, or

split compres

PWB

Cast-brace application or

sion fracrure

posroperarive knee brace AAROM exercise,

continuous passive

morion to knee joint,

or both

Displaced;

Sk eletal tractIOn and bed

Functional mobiliry NWB ,

impacted, or

rest (5 I wk) to allow for

TDWB ,orPWB

severely

soft tissue healing

Delayed knee NAAROM

comminuted

ORIF % bone graft

Positioning, breathing

bicondylar

Simultaneous ligamem or

exercise, and uninvolved

fracture

meniscal repair, if appli-

extremity exercise if on

cable

bed rest

Immobilization brace

AiAAROM = aCflvelacllve-assisted range of motton; AAROM = active-assisted range of

motion; NWB = non weight bearing; ORIF = open-reduction internal fixation; PWB =

partial weight bearing; TOWS = tOuch-down weight bearing.

Source: Data from AP Whittle. Fractures of Lower Extremity. In ST Canale (cd), Campbell's Operative Orthopaedics, Vol. 3 (9th ed). St. LoUIS: Mosby, 1998.