Fractures

Question 1

What are examples of how fractures are classified?

Answer 1

• Location in the bone
• Angle of the fracture
• Number of fragments
• Skin is open or closed
• • Skin is stable or unstable
• • Geometry: transverse, oblique, spiral, comminuted, vertical
• • Site: base, shaft, neck, or head
• • Deformity: rotational, angular, or with shortening (corresponds with stable vs unstable)

Question 2

What is a comminuted fracture?

Answer 2

• Involves shattering of bone into pieces; usually takes the longest to heal

Question 3

What is a compound or open g fracture?

Answer 3

• Bone pierces or lacerates through the skin

Question 4

What are examples of incomplete fractures?

Answer 4

• Greenstick fracture: characterized by a small crack and is most commonly found in children
• Hairline fracture: happens frequently in athletes

Question 5

What are examples of complete fractures?

Answer 5

• Simple fracture: transverse, oblique, spiral, impacted
• Fractures can be angulated, displaced, distracted, or pathological
• Growth plate fractures through the epiphyseal plate

Question 6

What is the general order fracture healing?

Answer 6

Inflammatory phase > regeneration > remodeling phase

Question 7

What is the timeline for the inflammatory phase after a fracture?

Answer 7

• 1-2 weeks

- Hematoma forms on the fracture site tissues come together to begin bone repair

Question 8

What is the timeline for the regeneration phase after a fracture?

Answer 8

• 2-6 weeks

- Healing takes place: regrowth of vascular tissue, soft callus turns into hard callus and direct union

Question 9

What is the timeline for the remodeling phase after a fracture?

Answer 9

• 6 weeks to a year
• Strong bone tissue/ossification is at the fracture site
• Rigidity of callus dramatically improves between 6-8 weeks

Question 10

T/F: ultrasound should not be applied over a fracture or epiphyseal plate.

Answer 10

True because it could stunt growth

Question 11

What factors affect the healing of a fracture?

Answer 11

• Age
• Presence of other disease
• Overall health
• Type of fracture and fracture characteristics
• • Amount of damage
• • Bone involved and location of fracture
• • Method of fixation (e.g., casted, surgery, pins, repositioning - open or closed)
• Nutrition
• Circulation
• Patient compliance

Question 12

What is an OTs role during fracture management?

Answer 12

• Splinting to provide protection, to immobilize, or to gain ROM
• Edema control via elevation, massage, ice (edema can cause scarring or turn into fibrotic tissue)
• Pain control/modalities (e.g., TENS, cryotherapy, hot packs, ultrasound, NMES)
• Regain ROM via gentle AROM, AAROM, PROM, and stretching
• Regain sensation:
• • Desensitization, Fluidotherapy
• • Neuromuscular reeducation
• • Proprioception (especially if there is ligament damage) and kinesthesia
• • Strengthening when healing of bone allows

*Always start with AROM when there is a fracture!

Question 13

What is included during an OT evaluation at the acute stage of healing?

Answer 13

• Pain level
• Edema
• Associated soft tissue injury
• ROM in involved or adjacent joints depending on precautions
• Inspect for any deformity or mal-alignment

Question 14

What are OT goals for a fracture?

Answer 14

• Protect the fracture via splinting and patient education
• Edema and soft tissue swelling/inflammation reduction
• Pain reduction
• ROM/mobility improvement
• Strength increased to functional level (LTG)
• Ability to perform previous occupational tasks (LTG)