i bc27f85be50b71b1 (73 page)

= 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