i bc27f85be50b71b1 (76 page)

exercise

Edema management

Forefoot; moderate or

ORJF

Sec Forefoot; minimally

severe displacement, Percutaneous pinning

displaced, above

with fragmentation

or angularion

SLC

Forefoot; open

See Calcaneal;

See Forefoot; minimally

open, above

displaced, above

ORIF

NWB = non weight bearing; ORIF = open-reduction internal fixatioll; PWB = partial

weight bearing; ROM = range of motion; SLC = short leg cast; WBAT = weight bearing

as tolerated.

'"For calcaneal fractures, cast application may not be in the neutral ankle position to

protect the fracture site from strong ankle muscle contractions.

Source: Data from JD Heckman. Fractures and Dislocations of the Foot. In CA Rockwood, DP Green, RW Bucholz, JD Heckman (cds). Rockwood and Green's Fractures in Adults (4th cd). Philadelphia: Lippincon-Raven, 1996.

252 AClITE CARE HANDBOOK FOR PHYSICAL TIIERAPISTS

Table 3-A.12. Management and Physical Therapy Imervention

for Common Cervical Spine Fractures

Physical Therapy

Fracture Type

Management Options

Intervention

Hangman's fracture,

Cervical collar immo

Functional mobility with

or bilateral pedicle

bilization for type I

logroll precautions

fracrure of axis IC I ) Cervical traction!

Posture and body

Type I-no angula-

reduction followed

mechanics training

tion and <3 mm

by halo vest for type

Therapeutic exercise and

displacement of

II and ItA (cervical

active-assisted/passive

C2 on C3

collar for type II

range of motion depcn

Type 11->3 mm

possible)

dent on neurologic

displacement of

Posterior open reduc

IIlJury

C2 on C3

tion and halo vest

Balance and scapular

Type !lA-minimal

or CT-3 fusion for

exercises for the patient

displacement and

type 11\

in a halo vest

significant angulation of C2

Type III-full unior bilateral facet

dislocation

Odontoid process

Cervical collar immo

See Hangman's fracture,

fracture

bilization for type I

or bilateral pedicle frac

Type l-

Closed reduction or

tUfe of axis (GI), above

avulsion fracture

ORIF with halo

of the tip of the

vest, amerior or

odontoid

posterior C 1-2

T ypc II-fracture of

fusion::!: bone graftthe neck of the

ing with cervical

odontoid

collar for type II

Type 1I1-fracture

Closed reduction or

extending ro the

open-reduction

C2 vertebral body

inrernal fixation

with halo vest for

type 11\

MUSCULOSKELt:.iAL SYSTEM APPENDlX 3�A

253

Physical Therapy

Fracture Type

Management Oprions

Intervention

Vertebral body (stable

Cervical collar

Functional mobility

wedge) fracture-

Posture and body

bony impacrion and

mechanics training

concavity of the ver-

tebral body

Spinous process

Cervical collar

Sec Vertebral body (stable

(stable, isolated) or

wedge) fracture, above

laminal fracture

j: = With or wlthom; ORIF = open-reduction internal fixarion.

Sources: Data from RC Sasso, TM Reilly. Odontoid and Hangman's Fractures. Orthopaedic Knowledge Update: Trauma (2nd ed). Rosemont, IL: American Academy of Orthopaedic Surgeons, 2000; and RS Hockberger, KJ Kirshenbaum, PE Doris. Spinal

Injuries. In P Rosen (cd), Emergency Medicine Conceprs and Clinical Practice (4th ed).

St. Louis: Mosby. 1998.

Table 3-A.13. Management and Physical Therapy for Common

Thoracolumbar Spine Fractures

Physical Therapy

Fracture Type

Management Options

Intervention

Spinous process,

Cervicothoracic or

Functional mobility with

rransverse process,

thoracolumbar

logroll precaurions

laminar, or facet

orrhosis

PoSture and body

fracture (stable,

mechanics training

isolated)

Therapeutic exercise and

active-assisted/passive

range of morion

dependent on

neurologic injury

Vertebral body com

Shorr-term bed rest

See Spinous process,

pression (impacted

Verrebroplasty

transverse process,

anterior wedge)

laminar, or facet

Thoracolumbar or rho-

fracture--srable

fracture (stable,

racolumbosacral

isolated), above

orthosis or hyperextension brace

Fusion (if severe)

254 AClJfE CARE HANDBOOK FOR PHYSICAL THERAPISTS

Table 3 - A.13. Continued

Physical Therapy

F ractu re Type

Management Options

Intervention

Vertebral body burst

Short-term bed rest

See Spinous process,

(axial compression)

Thoracolumbosacral

transverse process,

fracture-unstable

orthosis

laminar, or facer

fracrure (stable,

Anterior/posterior

isolated), above

decompression and

reconstruction :t:

bone grafting

Multidirectional frac

Anterior/posterior

See Spinous process,

ture with disc

decompression and

transverse process,

involvement and

fusion

laminar, or facet

facet dislocarion

Thoracolumbosacral

fracture (stable,

unstable

orthosis

isolated), above

:!: = with or without.

Source: Data from AR Vaccaro, K Singh. Thoracolumbar Injuries: Nonsurgical Treatment. DC Kwok. Thoracolumbar Injuries: The Posterior Approach. In Orthopaedic Knowledge Update: Trauma (2nd ed). Rosemont, IL: American Academy of Orthopaedic Surgeons, 2000.

Table 3 - A.t4. Management and Physical Therapy Intervention of

Proximal Humeral· and Humeral Shaft Fractures

Physical Therapy

F racture Type

Management Options

Intervention

Proximal humeral;

Closed reduction

Functional mobility

displaced, one-part

Sling immobilization

NWB

Pendulum exercises and

passive range of

motion per

physician

Elbow, wrist, and hand

range-of-morion

exercises

Edema management