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MUSCULOSKELETAL SYSTEM APPENDIX J-A 255

Physical Therapy

Fracture Type

Management Options

Intervention

Proximal humeral;

Closed reduction with

See Proximal humeral;

displaced, two-part

percutaneous

displaced, one-parr,

pinning

above

ORIF

Intramedullary rod

Sling immobilization

Proximal humeral;

ORIF

See Proximal humeral;

displaced,

Hemiarthroplasty

displaced, one-parr,

three-part

above

See section Physical Therapy Intervemion after

Shoulder Arthroplasty

in Chapter 3

Proximal humeral;

Transcutaneous reduc

See Proximal humeral;

displaced, four-part

tion with

displaced, three-part,

fluoroscopy

above

Percutaneous pinning

ORIF

Comminution of

Hemiarthroplasty

See Proximal humeral;

humeral head

Sling immobilization

displaced, one-part,

above

Humeral shaft; closed,

Closed reduction

Functional mobility

minimal

Sling, hanging arm

NWB

displacement

cast, or functional

Shoulder and elbow

brace

active/active-assisted

range-of-motion exercise per physician and

type of immobilization

Isometric scapulothoracic exercise

Wrisr and hand exercise

Edema management

256 ACUTE CARE HANDBOOK FOR PHYSICAL THERAPISTS

Table 3-A.14. Continued

Physical Therapy

Fracture Type

Management Options

Intervention

Humeral shaft; closed,

ORIF

See Humeral shaft;

displaced with

Intramedullary nails

closed, minimal

angularion

displacement, above

Long arm spline

Humeral shaft; open

irrigation and debride-

See Humeral shaft;

ment with immediate

closed, minimal

or delayed wound

displacement, above

closure

External fixation

ORIF

NWB = non weight bearingj ORlF = open-reduction internal fixation.

·Proximal humeral fractures according to the Neer classification.

Sources: Data from GR Williams, KL Wong. Two·Part and Three-Part Fractures: Open

Reduction and Inu:rnal Fixation Versus Closed Reduction and Percutaneous Pinning.

Orthop Clin North Am 2000;31: 1-21; and JO Zuckman, KJ Koval. Fractures of the

Shaft of the Humerus. In CA Rockwood, DP Green, RW Bucholz, JO Heckman (eds),

Rockwood and Green's Fractures in Adulrs (4th ed). Philadelphia: Lippincott-Raven,

1996.

MUSCULOSKEU-rAL SYSTEM API'ENDIX 3-A

257

Table 3-A.1S. Managemem and Physical Therapy Imervention for

Olecranon and Radial Head Fractures

Physical Therapy

Fracture Type

Management Options

Intervention

Olecranon; closed,

Long arm casr with

Functional mobility

non displaced

elbow in midflexion

NWB

Initiation of elbow activeassisted range of

motion in pain-free

range per physician

Distal and proximal joint

active range of motion

Edema management

Olecranonj closed,

ORIF

See Olecranonj closed,

displaced

nondisplaced, above

Olecranon; closed,

ORIF

See Olecranon; closed,

comminured

Immobilization

nondisplaced, above

Radial head; closed,

Closed reduction

See Olecranon; closed,

non-, or minimally

with early

nOlldisplaced, above

displaced

immobilization

Hemaroma aspirarion

Sling or short-term

splint

Radial head; closed,

Closed reduction and

See Olecranon; closed,

displaced

short-term splinting

nondisplaced, above

if range of motion

(ROM) adequate or

ORIF if ROM inadequate

Partial or total radial

head excision

Radial head; closed,

ORIF with

See Olecranon; closed,

comminuted

immobilization

nondisplaced, above

Radial head excision:t

radial head prosthesis, :t bone grafting

% = with or without; NWB = non weight bearing; ORfF = open-reduction internal fixation.

Source: Dala from RN Hotchkiss. Fractures and Dislocations of the Elbow. In CA

Rockwood, DP Green, RW Bucholz, JD Heckman (eds), Rockwood and Green's Fractures in Adults (4th ed). Philadelphia: Lippincott-Raven, 1996.

258 AClITE CARE HANDBOOK FOR PHYSICAL ll-IERAPISTS

Table 3 -A.16. Management and Physical Therapy Intervenrion for

Forearm Fractures

Physical Therapy

Fr:acture Type

Management Options

Intervention

Shaft fracture of

Closed reduction with

Functional mobility

radius or ulna

casting, or casting

NWB

alone if

Distal and proximal

nondisplaced

range-of-morion

ORJF (if displaced)

exercises

with functional

Edema management

brace

Distal radius;

Closed reduction and

See Shaft fracture, above

extra -articu la r

percutaneous

pinning

Sugar-tong splint

or c:ast

ORIF:t: functional

brace

Distal radius;

ORJF

Sce Sha ft fracturc, above

intra-articular

Closed reduction with

Active and passive finger

external fixation :t:

movemenr if patient

percutaneous

has an external fixaror

pinning

Arthroscopic controlled internal

fixation