physical therapy for holstein-lewis fracture

Introduction:

A Holstein-Lewis fracture is a special type of humeral shaft fracture that occurs in the distal end of the humerus. In this fracture the distal end of the humerus is radially displaced, the characteristic feature of a Holstein-Lewis fracture is simple spiral fracture of the distal humerus. 

This picture is commonly associated with neuropraxia (temporary nerve dysfunction) of the radial nerve. The incidence of radial nerve palsy in Holstein-Lewis fracture is approximately 22%. In this article you would read everything about physical therapy for holstein-lewis fracture.

Clinical presentation of Holstein-Lewis fracture: 

* Pain

* Extremity weakness

* A characteristic deformity known as wrist drop (due to radial nerve dysfunction)

 

How is an oblique Humerus fracture treated? 

An oblique humorous fracture is a type of broken bone where the fracture line runs diagonally across the humerus (upper arm bone) . Let's explore the treatment options for this specific fracture: 

1. Non operative treatment:

➡️ Fracture brace:  In the initial period of fracture, a fracture brace (which looks like a clamshell) can be used to hold the humorous and proper position.

➡️ Splint:  For the reduction of swelling or edema the fracture maybe treated with a splint or sling. As healing progresses, patients can gradually begin using their shoulder and elbow while wearing the brace.

2. Physical therapy:

Regardless of the treatment approach whether it may be operative or non operative, physical therapy is very crucial. It helps the patient to regain the ability to move their arm, and restore strength, with overall improve in function and mobility.

Also read- When should I start physical therapy after a fracture.

How long is Physical therapy for a proximal humerus fracture?

The duration of physical therapy for a proximal humerus fracture can vary depending on the severity of the fracture and the individual’s progress in healing and rehabilitation. Generally, most proximal humerus fractures heal within 3 to 4 months. Here’s a general timeline:

• Initial Weeks (1-3 weeks): You may feel the fracture fragments shift as you move your arm, which is normal for fractures not treated with surgery. Gentle exercises to regain motion may begin as soon as you can tolerate it.

• Intermediate Phase (3 weeks to 2-3 months): After the initial weeks, more aggressive shoulder strengthening exercises can resume. The goal during this phase is to restore shoulder function.

• Long-Term Recovery (3-4 months): Full healing typically takes about three months, but even if surgery is performed, recovery of full function often takes as long as 18 months.

• Full Recovery: Can take up to 6 months to a year. Some patients may continue to see improvements for up to 18 months, especially if they had surgery.

It’s important to follow the guidance of physical therapists throughout the recovery process to ensure safe and effective healing.

Also read- How do you know when you need Physical therapy

How can I prevent stiffness in my shoulder after a fracture?

Preventing stiffness in your shoulder after a fracture is crucial for a good recovery. Here are some strategies to help maintain mobility and reduce the risk of stiffness:

• Early Movement: Begin gentle passive exercises to keep the joint mobile without stressing the healing bone.

• Pain Management: Use pain medication, rest, and ice therapy as recommended by your healthcare provider to control pain, which can help you move more comfortably.

• Use of Sling: While a sling may be necessary for comfort and support, it’s important to remove it periodically to move your wrist and elbow, which helps prevent stiffness in the shoulder.

• Physical Therapy: Engage in physical therapy exercises as prescribed by your therapist. Once the bone begins to heal, gentle shoulder and elbow exercises can help prevent stiffness and weakness.

• Follow-up Care: Regular follow-ups with your healthcare provider are essential to monitor healing and adjust your rehabilitation program as needed.

Remember, these are general guidelines, and it’s essential to follow the specific advice given by your healthcare professional for your unique situation. Always consult with them before starting any new exercise or therapy regimen.

Also read- Benefits of physical therapy for my health and fitness

Which splint is use in Holstein lewis fracture?

A coaptation splint is a type of splint used primarily to immobilize and stabilize fractures, particularly those of the humeral shaft. It’s designed to approximate the broken bone ends to aid in the healing process. The splint typically extends from the medial aspect of the arm near the axilla, wraps around the elbow, and reaches up to the acromioclavicular joint. It’s important to apply generous padding to prevent discomfort, especially in the axilla (armpit area), and to secure the splint with bandages, such as an ace wrap.

The application process involves several steps:

1. Assessing the pre-procedure neurovascular status, which includes checking the distal pulse, motor function, and sensation.
2. Measuring and preparing the splinting material, which may involve using the contralateral (opposite) extremity for reference.
3. Applying stockinette and padding, ensuring extra layers over bony prominences.
4. Molding the lightly moistened splinting material to the desired shape and maintaining the position until it hardens.
5. Re-checking and documenting the neurovascular status post-application.

This type of splint is often used temporarily until permanent stabilization can be performed, such as plating a fracture, or it can be used as the primary means of fixation. It’s a common method employed in emergency settings to quickly stabilize fractures before further treatment.

What is the commonest complication of fracture of the midshaft of the humerus?

The most common complication of a midshaft humerus fracture is injury to the radial nerve. This nerve runs in close proximity to the humerus, and a fracture can lead to nerve damage, resulting in symptoms such as weakness, numbness, and difficulty in wrist and finger extension. Another frequent complication is nonunion, where the broken bone ends fail to heal together properly. These complications underscore the importance of careful management and monitoring of humeral shaft fractures.