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Fractures

Types of fractures and tips for intervention

QuestionAnswer
Colles' Distal Radius DORSAL displacement
Smith Distal Radius VOLAR displacement
Boxer's fracture 5th metacarpal / Ulnar gutter splint
Tips for intervention DO NOT assess ROM or STRENGTH until physician's order (humerus fracture is the exception?) (arthrodesis means joint fusion)
Kleinert Protocol Early mobilization program for flexor tendons. Passive flexion with use of rubberbands active extension to confines of splint.
Kleinert Protocol 0-4 weeks Early Phase: dorsal block splint: 20-30 degrees of wrist flexion, 50-60 degrees of MCP flexion, and IP extension. Have patient perform passive FLEXion and active EXTENsion within limits of splint.
Kleinert Protocol 4-7 weeks Intermediate Phase: Continue splint-adjust wrist to neutral. Have patient perform tendon gliding exercises (straight/hook/fist/tabeltop/straight fist) and scar management..
Kleinert Protocol 6-8 weeks Discontinue splint. Have pt perform AROM and light ADLs.
Kleinert Protocol 8-12 weeks Strengthening and leisure activities.
Duran Protocol The other or alternative flexor tendon early mobilization program.
Duran Protocol 0-4.5 weeks Again Dorsal block splint. PASSIVE Flexion / 10 reps per hour.
Duran Protocol 4.5 -6 weeks ACTIVE flexion and extension within limits.
Duran Protocol 6-8 weeks Tendon gliding exercises, scar management, and light ADLs.
Duran Protocol 8-12 weeks Strengthening and work activities.
Arthritis Deformities and Tips Boutonniere, Swan Neck (and Mallet Finger is a fracture) FOCUS on AROM and only PROM if patient cannot perform AROM. Nodes at the PIP joints = Bouchard's, and at the DIP joints = Herberden's. AVOID strength testing (if necessary sphymomanometer) try to re
Boutonniere PIP Flexion and DIP Hyperextension. Central Slips (split in tendon) of the extensor digitorum communis tendons.
Swan Neck PIP Hyperextension and DIP flexion
Mallet Finger (really a fracture no AD) Flexion of DIP (extensor tendon tear)
Extension Tendon Mobilization Zones
Extension Tendon Mobilization I-II Mallet Finger. 0-6 weeks DIP extension splint.
Extension Tendon Mobilization III-IV Boutonniere. 0-4 weeks PIP extension splint (DIP free). 4-6 weeks begin AROM and flexion to DPC
Extension Tendon Mobilization V-VII 0-2 weeks:Volar wrist splint (wrist 20-30 degrees of extension, MCP 0-10 flexion, and IP in extension). 2-3 weeks: shorten splint to release IP joints.4 weeks: remove splint/AROM. 5 weeks:wear splint inbetween exercising/AROM of wrist. 6 weeks: D/C splint
Isometric versus Isotonic Contractions Isometric - contraction without movement. Isotonic - contraction with movement (eccentric isotonic / concentric isotonic)
Created by: hesselrach