Fracture

  1. Type
  2. Fracture name
    • Colles’
      •  type of fracture of the distal forearm in which the broken end of the radius is bent backwards
      • Complications may include damage to the median nerve.
      • It typically occurs as a result of a fall on an outstretched hand.
      • Risk factors include osteoporosis.
      • The tip of the ulna may also be broken.
    • Galeazi
    • Pott’s
    • Dupuytren’s
  3. Common site of stress fractures : tibia, metatarsals, navicular, femur and pelvic
  4. Staging of healing
  5. Massage contraindication
    • During immobilization
      • No traction before union has occurred
      • No hot hydro distal or immediately proximal to cast — causes congestion under cast
      • If fracture was a muscle attachment site, Active Free and Active Resisted Testing should only be performed with MD approval
      • With open reduction, on site work avoided until skin is healed
      • With stress fracture, on-site work CID while site is tender
    • Immobilization removed
      • Overpressure contraindicated before consolidation
      • No extreme temperature hydro on tissue under cast — perception of temperature may be altered
      • No deep longitudinal technique on muscle until tissue health and muscle tone are regained. Passive stretch done carefully
      • No hot hydro with pins or metal plates
  6. Massage treatment
    • During Fracture Immobilization
      • Cool hydrotherapy, applied distal to the cast
      • Manual Lymphatic Drainage proximal to the cast
      • Limb proximal to cast treated with effleurage, petrissage, kneading to reduce pain, hypertonicity, as well as to increase drainage, venous return
      • No traction before union occurs
      • Mid-range pain-free Passive ROM to proximal and distal limbs
      • Vibrations through cast can decrease SNS firing
      • Work distal to cast restricted to light stroking, muscle squeezing, vibrations
    • Start the two-week count from when the cast was removed.
      • Mild contrast hydrotherapy ( to increase circulation) to tissue that was under cast
      • Proximal Manual lymphatic Drainage if edema still present
      • Proximal limb treatment to decrease Hypertonicity and Trigger Point
      • Stimulating, light techniques on muscle with atrophy. Gentle petrissage, muscle squeezing, shaking, point kneading, light tapotement
      • Pain free passive and active ROM — until tone has improved, do not put a stretch on muscles
    • Around after 2 weeks ( standard but not for everyone)
      • fascial techniques 
      • Friction
      • Trigger point
      • Swedish massage
      • Pain free passive stretch to muscles to re-align fibers
      • Once consolidation has occurred, joint play is indicated to joints beneath cast to restore ROM
  7. Self-care
    • During immobilzation
      • Hydrotherapy : cold and cool on distal to cast
      • For the compensating structures : stretch
      • AF rom of the joints distal to the cast
      • Strengthening under the cast : susbmaximal isometric exercise
    • Immobilization removed
      • Hydrotherapy : when the cast is first removed are cool or mid contrast on site. Gradually increasing the temperature
      • For the compensating structures : stretch
      • AF ROM onsite → AR rom
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