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248 ACUTE CARE HANDBOOK FOR PHYSICAL THERAPISTS

Table 3-A.9. Medical-Surgical Management and Physical Therapy

Intervention for Tibial Shaft Fractures

Fracture Type

Management Options

Physical Therapy lntervenrion

Closed; minimally

Closed reduction

Functional mobility IDWB,

displaced

Long leg casr

PWB, or WBAT

Quadriceps strengthening

Edema management

Closed; moderately

Open-reduction inter-

Functional mobility N\VB,

displaced

nal fixarion (ORIF)

TDWS

Short leg cast

Knee ROM exercise

Quadriceps strengthening

Edema management

Closed; severely

External fixation

Functional mobility N\VB

displaced,

Temporary calcaneal

Ankle;t; k nee ROM exercises

comminured,

traction [Q allow for

Quadriceps strengthening

or borh

soft tissue healing

Edema management

ORIF

Open

External fixation

See Closed; severely displaced,

comminuted, or both, above

� = with or without; NWB = non weight bearing; PWB = parrial weight bearing; ROM =

range of motion; TOWB = touch-down weight bearing; WBAT = weight bearing as tolerated.

Table 3-A.I0. Medical-Surgical Managemenr and Physical Therapy

Intervention for Distal Tibial and Ankle Fractures

Medic.al-Surgical

Physical Therapy

Fracture Type

Options

Intervention

Distal tibial;

Closed reduction

Functional mobility NWB

closed, mini

Short leg cast

Knee ROM exercises

mally displaced

Proximal joint strength-

ening

Edema management

Distal tibial;

ORIF

See Distal tibial;

closed, moder

Short leg cast

closed, minimally

ately displaced

displaced, above

MUSCULOSKE.LETAL SYSTEM APPENDIX J-A

249

Medical-Surgical

Physical Therapy

Fracture Type

Options

Intervention

Distal tibial;

Temporary calcaneal

Functional mobility NWB

closed, severely

traction

Lower-extremity isometdisplaced

External fixation

riCS

ORIF

Neutral ankle positioning

Proximal joinr strengthen-

ing

Edema management

Distal tibial; open

External fixation

Functional mobility NWB

Ankle ROM exercise

Neutral ankle positioning

Proximal joint strengthening

Edema management

Ankle; closed,

Closed reduction

Functional mobility NWB

nondisplaced

Short leg cast or walkor PWB

ing cast

Edema management

Proximal lower-extremity

strengthening exercise

Ankle; closed, dis

Closed reduction

Functional mobility NWB

placed, multi

ORIF

Edema management

fracture, or both Cast application or

Proximal lower-extremity

other immobilization

strengthening exercise

method dependenr on

Foot and ankle exercise as

degree of edema

per physician and type of

immobilization device

Ankle; open

Irrigation and debride

See Ank le; closed, dismenr with immediate

placed, multi fracture,

or delayed wound

or both, above

closure

Tracrion

External fixation

ORIF

NWB = non weight bearing; ORJF = open-reduction inrernal fixarion; PWB = partia l

weight bearing; ROM = range of morion.

Source: Data from WB Geissler, AK Tsao, JL Hughes. Fracrures and Injuries of rhe

Ankle. In CA Rockwood, Dr Green, RW Bucholz, JD Heckman (cds), Rockwood and

Green's Ff3crurcs in Adults (4rh cd). Philadelphia: Lippincott-Raven, 1996.

250 AClITE CARE HANDBOOK FOR PHYSICAL THERAPISTS

Table 3-A.l1. Management and Physical Therapy lntervention for

Calcaneal and Forefoot Fractures·

Physical Therapy

Fracture Type

Management Options

Intervention

Calcaneal; extra-

Closed reduction

Functional mobility

articular, minimally

SLC

NWB

displaced

Proximal lower-extremity

strengthening and

ROM exercise

Edema management

Ank le/forefoot exercise as

per physician and type

of immobilization

device

Calcaneal; avulsion

Closed reduction

See Calcaneal; extra-

ORIF

articular, minimally

displaced, above

SLC

Calcaneal; intra-

Sk eletal traction

See Calcaneal; extra-

articular fracture

Immediate or delayed

articular, minimally

involving the

SLC

displaced, above

subtalar joint

Closed reduction and

percutaneous

pinning

ORfF

Arthrodesis if fracture

IS very severe

Calcaneal; open

Irrigation and dehride-

See Calcaneal; exna-

menr with immedi-

articular, minimally

a te or deJa yed

displaced, above

wound closure

Skeletal traction

External fixation

MUSCULOSKELETAL SYSTEM APPENDIX 3-A

251

Physical Therapy

Fracrure Type

Management Options

lnrervention

Forefoot; minimally

Closed reduction

Functional mobility

displaced

Percutaneous pinning

NWB,PWB ,or

WBAT, dependent

SLC or walking cast

on exact location

and severity of fracture

Proximal lowerextremity strengthening and ROM