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Authors: Unknown
= open-reduction internal fixation; PWB = partial weight bearing, WBAT = weight bear
IIlg as rolet:ned.
�Rarely used secondary to risk of disimpacrion of the fracture. Considered if the patient
is agile and extremely compliant with NWB.
bGarden II is considered unstable despite non displacement because of a lack of bone
impaction of rhe femoral head.
Source: Data from JL Guyron. Fractures of Hip, Acetabulum, and Pelvis. In ST Canale
(cd), Campbell's Operarive Orthopaedics, Vol. 3 (9th cd). S1. Louis: Mosby, 1998.
242 ACtJfE CAR.E HANDBOOK FOR PHYSICAL THERAPISTS
Table 3-A.4. Evans and Russell-Taylor Classification, Management, and Physical Therapy intervention for Intertrochanteric and Subtrochanteric Fractures Management
Physical Therapy
Fracture Type
Options
Intervention
intertrochanteric, Evans type I
Closed reduc-
Functional mobility PWB
(fracture line extends
rion internal
Gentle hip ROM exercise
upward and outward from
fixation
Distal LE strengthening
the lesser trochanter)
(CRIF)
exercises
ORIF
intcrrrochameric, Evans type
ORIF
Functional mobility
II (fracture line extends
TOWS
�
osteotOmy
down and outward from
and bone
Gentle hip ROM exercise
lesser trochanter)
grafting
Distal LE strengthening
Bipolar
exercise
arthroplasty
Subtrochanteric, Russell
ORIF
See Intertrochanteric,
Taylor type LA (single
1M rod
Evans rype I, above
fracture line extends from
below lesser trochanter ro
the distal greater
trochanter)
Subtrochanteric, Russell
ORIF
See Intertrochanteric,
Taylor rype IB (as in rype IA
1M rod
Evans type I, above
with a second fracture line
to the superior aspect of the
lesser trochanter)
Subtrochanteric, Russell
ORIF/OHS
See Intertrochanteric,
Taylor rype IIA (single
1M rod
Evans type I, above
fracture line extends from
below the lesser trochanter
into the greater trochanter)
Subtrochanteric, Russell-Tay-
ORIFfDHS
Functional mobility
lor type liB (as in type IIA,
Bone grafting
NWBorTOWB
with a second fracture line
Gentle hip ROM exercise
to the superior aspect of the
Distal LE strengthening
lesser trochanter)
exercise
'" = with or without; DHS = dynamic hip screw; 1M = intramedullarYi LE = lower
extremity; NWB = non weight bearing; ORIF = open-reduction internal fixation; PWB
= panial weight bearing; ROM = range of motion; TOWB, rouch-down weight bearing.
Source: Dara (rom J L Guyron. Fractures of Hip, Acetabulum, and Pelvis. In ST Canale
(cd), Campbell's Operative Orlhopaedics, Vol. 3 (9th cd). St. Louis: Mosby, J 998.
MUSCULOSKELETAL SYSTEM APPENDIX 3-A
243
Table 3-A.5. Management and Physical Therapy Inrervenrion for Femoral
Shaft Fractures
Physical Therapy
Fracture Type
Management Options
Intervention
Closed; simple or non1M rod
Functional mobility
displaced
ORIF
NWB, TDWB, or
WBAT
Gende ROM exercise
Closedj comminuted,
Traction on bed rest
Functional mobiliry
impacted, or both
1M rod
NWBorTDWB
ORIF
Lower extremity
ROM exercise per
physician order
Positioning, breathing
exercise, and uninvolved extremity
exercise if on bed
rest
Open; comminuted
Irrigation and debride
See Closed; commiand displaced
menr with immedinuted, impacted, or
ate or delayed
both, above
wound closure
Short-term skeletal
traction on bed rest
External fixation
1M rod
1M = intramedullary; NWS = non weight bearing; ORIF = open-reduction internal fixation; ROM = range of motion; TOWS = touch-down weight bearing; WSAT = weight bearing as tolerated.
Source: Data from JL Guyton. Fractures of Hip. Acetabulum, and Pelvis. In ST Canale
(ed), Campbell's Opera rive Orthopaedics. Vol. J (9th ed). St. Louis: Mosby, 1998.
244 AClITE CARE HANDBOOK FOR PHYSICAL THERAPISTS
Table 3 -A.6. Management and Physical Therapy Intervention for Distal
Femur Fractures
Management
Fracture Type
Options
Physical Therapy Intervention
Supracondylar;
Long leg cast
Functional mobility NWB
extra-articular,
Distal and proximal
simple,
NAAROM exercise
nondisplaced
Supracondylar;
Traction on bed rest
Functional mobiliry light
extra-articular,
Closed reduction
PWS
displaced, or
with percutaneous
Distal and proximal
comminured
plare fixation
NAAROM exercise
Intramedullary nail
Positioning, breathing exercise,
ORIF
and uninvolved extremity
exercise if on bed rcst
Knee immobilizer or
hinged k nee brace
(stable fixarion) or
casr (less-stable
fixation)
Continuous passive
motion
Unicondyiarj intra-
Long leg cast with
Functional mobility NWB or
articular,
close monitoring
TOWS
nondisplaced
for loss of reduction Distal and proximal
NAAROM exercise
Unicondylar; intra-
Traction on bed rest
Functional mobility TDWS
articular,
Closed-reduction
Genrle ROM exercise
displaced
and percutaneous
Conrinuous passive motion
fixation
per physician order or rype
OR IF
of immobilization device
Long leg splint
or cast
MUSCULOSKELETAL SYSTEM APPENDIX 3-A
245
Management
Fracture Type
Options
Physical Therapy Intervention
Inrercondylar;
Long-term traction
Functional mobility
intra-articular
ORIF
TDWB or light PWB
Cast brace if less
Delayed gentle ROM and
stable fixation
quadriceps exercise
achieved
Maintenance of functional
ROM of hip and ank le
A1AAROM = nctive/active-assisted range of motion; NWB = non weight bearing; ORIF
= open-reduction internal fixation; PWB = partial weight bearing; ROM = range of