Introduction:
On the basis of aetiology fracture can be of two type first is traumatic fracture and second is pathological fracture. Also on the basis of relationship with an external environment fracture can be a simple or closed fracture and second is compound or open fracture.
Simple or close fracture- A fracture which does not communicate with the external environment is simple or closed fracture, i.e., the overlying skin and other soft tissues are intact.
Compound or open fracture- In this type the fracture communicates with the exterior through a wound over the fracture, there is a breakdown in the overlying skin and soft tissues.
The following terminologies are used to describe a fracture
1. Transverse fracture
2. Communited fracture
3. Spiral fracture
4. Compression fracture
5. Oblique fracture
6. Segmental fracture
Diagnosis of fractures:- the diagnosis can be arrived at from the following:
1. History- the mechanism of injury provides a useful clue to the expected site and type of the fracture.
2. Muscle spasm- muscle tenderness and loss of movement at the adjacent joint are the immediate signs. In the lower extremity fractures the patient is unable to bear body weight. These signs and symptoms are due to the natural body protector reflexes to immobilize fractured bones.
3. Oedema-the soft tissue injury accompanying fracture often results in hematoma, and edema over the fracture site. The process of repair begins with inflammation.
4. Warmth- There may be increase in the local temperature due to the rush of blood to the area of injury.
5. Radiography- it is an important tool in the diagnosis of a fracture.
Fracture healing
The healing of fractures is in many ways similar to the healing of soft tissue wounds, except that the end result is a bond. A fracture begins to heal as soon as the bone is broken.
There are stages in fracture healing of cortical bone so the first stage is
1.Stage of hematoma- blood leaks out through the torn vessels in the bone and forms a hematoma between and around the fracture, this stage last less than 7 days.
2.Stage of granulation tissue- in this stage the precursor cells produces cells which differentiate and organised to provide blood vessels, fibroblasts, osteoblasts etc. The fracture is still mobile and still last up to 2 to 3 weeks.
3.Stage of callus- In this stage granulation tissue differentiates further and creates osteoblast which results in formulation of the callus also called woven bone, the callus is the first sign of union visible on X-rays. The fracture is clinically United and this stage last up to 2 to 3 months.
4.Stage of remodelling- The process of remodelling ends by reconstruction of the new bone similar to the one before injury. The soft callus gets hardened and the lamellar bone formation occur by callus, this stage last up to 1-2 years.
Physical therapy management of fractures or post fracture physical therapy:-
Physical therapy plays a significant role in the return of function following fractures. Physical therapy has a important role in the management of fracture and bringing the patient in to it's original position after injury. Physical therapist faces a challenge in regaining the functional independence in a patient with complicated multiple fractures, mismanaged fractures, non-unions and fractures where surgery is contraindicated.
A physical therapist has not only to use professional skill but also has to modify the procedures of physical therapy to suit each stage of healing of the fracture. After the fracture is held or the cast has been removed physical therapy is continued for 3 to 12 months or until you have regain your full level of function, the principal functions of a physical therapist are:-
1. Physical assessment which includes joint, muscle, tendon of the fractured area.
2. Identification of the nature of injury
3. Planning of the procedures of physical therapy on an individual basis.
Due to the fracture the fracture site has pain with movement, mobility of the joint near the fracture is also decreased which results in the decrease of joint play and also there is scar tissue adhesions over the fracture site which decreases the strength and endurance of muscles around the fracture site.
So the plan of care of physical therapist is to initiate active exercises along with increase joint and soft tissue mobility and also increase strength and muscle endurance along with educating the patient.
Physical therapist begin with gentle stretches and joint mobilization techniques which are very effective for regaining lost join play without traumatizing the articular cartilage or stressing the fracture site. After that therapist progresses the intensity as joint reaction becomes predictable.
➤Neuromuscular inhibition techniques were also performed by physical therapist once the bone is healed.
➤Near fractures site there is also scar formation so techniques for scar mobilization is also performed by physical therapist.
➤Isometric and isotonic exercises where also performed under the supervision of a physical therapist.
➤Physical therapist helps to improve strength, endurance, and flexibility of the muscles around the fracture area. The techniques performed in such a manner that it should be simple, objective, and within the limits of discomfort.
➤Along with manual techniques performed by physical therapist there are also some electro therapy modalities which were used by therapist in order to reduce the pain of the fracture site, some machines which are used are LASER, ultrasound, paraffin wax bath, TENS, hot or cold pack.
➤If there is a fracture of leg then weight bearing exercises were also performed by the physical therapist.
conclusion:
As we come to know that fracture at any part of our body affects the lifestyle of our daily routine so Physical therapy facilitates fracture healing and helps in speedy recovery. If you like the above article please let me know in the comment section.
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