FRACTURES JOINT REPLACEMENT SPORTS MEDICINE HUMERUS FX ORIF PROTOCOL (PROXIMAL, MIDSHAFT, or DISTAL ORIF) Dr. Sean Griffin Weeks 1-4 • Wear the sling full time for 2 weeks, and then only wear when outside the home for 4 more weeks. • Sleep with arm out of sling, straight on pillows with arm elevated for edema reduction REHABILITATION GUIDELINES FOR PROXIMAL HUMERUS FRACTURE (NON-OPERATIVE) 3 | P a g e Appointments Continue physical therapy 1-2 x/week Rehabilitation Goals • Increase RTC strength • Restore scapula-humeral rhythm Precautions • None Suggested Therapeutic Exercises • Posterior capsule stretching if indicate
Distal Humerus Fracture Open Reduction and Internal Fixation !erapy Instructions - Early Motion Protocol Laith Al-Shihabi, MD 1 week Splint: -Fashion removable long-arm splint holding the elbow in 90 degrees of !exion and wrist in neutral at 1 week post-op . Conservative treatment is short arm casting for 6-8 weeks with close monitoring, as some nondisplaced fractures may displace while casted. These may require a hook excision. The most significant impairment is the loss of grip strength
Mobilization with physical therapy is begun immediately following surgery. Humerus Shaft Fracture. A humerus shaft fracture may be treated with or without surgery, depending on the fracture pattern and associated injuries (i.e., nerve injury or open fracture). A temporary splint extending from the shoulder to the forearm and holding the elbow. The Supracondylar fracture of the humerus is a fracture of the distal end of the humerus just above the elbow joint. The transverse section of the shaft of the humerus is somewhat circular in shape which gets more flattered as it descends down to meet the distal end of the humerus
Proximal Humerus Open Reduction & Internal Fixation (ORIF) Day of Surgery A. Diet as tolerated. B. Icing is important for the first 5-7 days post-op. While the post-op dressing is in place, icing should be done continuously. Once the dressing is removed on the first or second day, ice is applied for 20-minute periods 3-4 times per day Proximal Humerus Fracture Open Reduction Internal Fixation Activity • Try and rest the first few days following surgery. Wear your sling at all times, including sleeping. You will be directed by Dr. Murar as to when you may discontinue your sling Physiotherapy Protocols 403 - 233 Nelson's Crescent New Westminster BC V3L0E4 _____ Shoulder Fracture ORIF: Postoperative Protocols (ORIF Proximal Humerus Fractures) General Rehabilitation Guidelines Tuberosities are repaired and bony healing must occur before stress is applied to rotator cuff tendons Precaution
Proximal Humeral Fracture Protocol Jay Carson, MD Rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. If a fracture or fracture repair is stable, then therapy should be started early. The most useful rehabilitation protocol is the three-phase system FOLLOW A PROXIMAL HUMERUS FRACTURE? Proximal humerus fractures sometimes result in stiffness of the shoulder, elbow, or hand. Such stiffness often requires physical therapy to help get back to normal motion. Additionally, fractures of the shoulder can bring about nerve injuries or other nerve conditions such as carpal tunnel syndrome .
Proximal Humeral Fracture Post-Surgical Rehabilitation Protocol (OPEN REDUCTION / INTERNAL FIXATION) General Principles: 1. Bony healing occurs usually within 6 to 8 weeks in adults. 2. Return to normal function and motion may require 4 months - 6 months. Overall Goals: 1. Increase ROM while protecting the fracture site. 2 Rehabilitation Protocol Humeral Shaft Fracture (ORIF) PHASE I: Protected ROM (6 weeks) Keep dressing in place, you may shower directly over clear plastic. Sutures are all underneath the skin and will dissolve on their own. Ice or cold flow systems encouraged for the first week at a minimum: should be used 3-4 times per day American Physical Therapy Association Serial Assessment and Treatment of a Humeral Fracture GARY L. SMIDT,* LPT, PhD Clinical problems at the glenohumeral joint, whether chronic or induced by trauma, tend to manifest joint hypomobility with accompanying. muscle weakness. Fractures at the proximal hu
Humeral shaft fractures in children under four years should lead the examiner to be alert for other signs of non-accidental injury. This fracture is a hallmark of non-accidental injury. Spiral fractures of the humerus in infants and toddlers are strongly linked with non-accidental injury Fracture shaft of the humerus. The most common site of fracture is at the junction of proximal 1/3rd and distal 2/3rd. The fracture can happen due to the direct injury or assault on the arm. It can also happen due to sudden and opposite movement of the arm against the violent contraction of the muscle Non-Operative Proximal Humerus Fracture Rehab Protocol This protocol provides the physical therapist with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement Proximal Humerus Fracture - Non-operative Three times per day home exercise program including: Phase 1: Week 0-4 (starting immediately) • Maintain sling use, keep elbow supported, no shoulder ROM, avoid firing shoulder muscles • OK to come out of sling for: o hygiene (ok for axillary hangs, no pendulum swings or Codman' Humerus fractures are common. The humerus is the long bone in your upper arm. A fracture is a broken bone. The humerus is most frequently fractured as the result of a fall or motor vehicle crash. Depending on the location and severity of the fracture, some bones may heal without surgery
Physical Therapy Protocols. Upper Extremity. AC Joint Reconstruction. Arthroscopic Bankart (Anterior Labrum Repair) Shoulder Arthroscopy with Biceps Tenodesis. Clavicle Fracture Fixation. Distal Biceps Repair. Humeral Shaft Fracture Fixation. Humeral Shaft Fracture (Non-Operative) Latarjet . Pectoralis Major Repair. Posterior Labrum Repair. !erapy Instructions - Early Motion Protocol Laith Al-Shihabi, MD 2-6 weeks Focus on recovery of !nger, then wrist, motion within the early postoperative period. Splint: -Fashion a removable forearm fracture brace along the full length of the forearm holding the wrist in 20-30 degrees of extension
Proximal Humerus (Upper Arm) Fractures: A Guide to Recovery After Surgery www.rebalancemd.com • 104 - 3551 Blanshard St. Victoria BC V8Z 0B9 • tel 250 940 4444 • fax 250 385 9600 Page 3 April 2015 v1/S. Mathes Return to Work: When you are able to return to work depends on: o the kind of job you have and its physical demand Following a proximal humerus fracture, physical therapy will be crucial to restore proper function of your shoulder and arm. If surgery is required, physical therapy will typically begin 1 to 4 weeks following the surgery, depending on the specific surgical intervention required. If surgery is not required, your physician and physical therapist. Proximal humerus fracture rates will continue to increase with the aging population 5-7,58 and the concomitant rise in osteoporosis. 50 These fractures can cause prolonged and severe disability and often are underestimated when compared with hip fractures. 25 This will increase the demands on health providers further, and some suggest that society faces an epidemic of fractures in the elderly. Introduction. Proximal humerus fractures account for 6% of all fractures in the Western world. 1 Following the distal radius and vertebra, it is the third most common osteoporotic fracture. 2 Around 85% occur in people older than 50, and the incidence peaks in the 60- to 90-year-old age-group with a female to male ratio of 70:30. 1(p. 691-697) A 2006 Finnish study estimated the incidence of. Surgical treatment of femoral shaft fractures with an IM nail is considered the standard of care with union rates between 95% and 99%, 13 Despite this success, functional limitations and impairments often persist after the injury and surgical procedure, which may result in residual disability. 2,3,13 This disconnect between fracture union and.
. Use the information below to gain a better understanding of your injury and what can be done to maximise your recovery via YouTube Captur
After distal humerus fracture fixation, the proximal ulna can be reattached by using standard Arbeitsgemeinschaft für Osteosynthesefragen (AO)-Association for the Study of Internal Fixation (ASIF) tension band wire technique and either two parallel .0625-mm K-wires or a 6.5-mm partially threaded cancellous screw, as described previously. The indications for physical therapy after supracondylar humeral fractures in children are not clear in the literature, even in the presence of an active or passive limitation of elbow joint motion. Much of the controversy is partly due to an initial recovery in elbow motion with progressive improvements for up to a year regardless of physical. surgical neck and proximal shaft that would require an extensive exposure for plating 3) Pathologic fractures of the proximal humerus 4) Osteoporotic bone? Advantage plating: 1) Best screw fixation can be achieved in the central aspect of the humeral head Proximal Humerus fracture. You have sustained a fracture to your shoulder. The shoulder is a ball and socket joint and you have fractured just below the ball part. This normally takes between 6 to 12 weeks to unite (heal). Once the fracture begins to heal it is important to keep the shoulder moving to overcome the stiffness but not to aggravate.
The occurrence of proximal humerus fractures will continue to rise with the increasing elderly population. Many patients with proximal humerus fractures have osteoporosis and have poor neuromuscular control mechanisms. In the United Kingdom most patients are immobilized routinely for 3 weeks or longer and are referred for physical therapy. A distal humerus fracture is a break in the lower end of the upper arm bone (humerus), one of the three bones that come together to form the elbow joint. A fracture in this area can be very painful and make elbow motion difficult or impossible. Most distal humerus fractures are caused by some type of high-energy event—such as receiving a. Most mid-shaft humerus fractures, which have well-aligned bone parts, can heal with immobilization and usually do not require surgery. Doctors may recommend physical therapy depending on bone healing. Therapists will help you move the shoulder joint at first with a passive range of motion exercises. These exercises help improve circulation and. ROM exercises and strengthening can be approached as previously described for proximal humerus fractures, with the patient referred to physical therapy if progress is slow. from Fracture Management for Primary Care E-Book by M. Patrice Eiff, Robert L. Hatch Elsevier Health Sciences, 2011: If the humerus is fractured, a body wrap is also applied
Most proximal humerus fractures occur in the surgical neck region where the ball-shaped head of the bone and the shaft come together. This injury is usually followed by bruising, swelling, pain and, in some cases, deformity. Causes A strong blow or fall is the most common cause of a proximal humerus fracture Signs of Spiral Fracture of Humerus. You may develop a spiral fracture pattern in the humerus due to some twisting injuries. You develop it in the shaft of the humerus when you lock your lower arm or have it trapped in machinery while the body rotates. Similarly, direct twisting forces applied during arm wrestling or throwing may also cause a.
Proximal humerus fractures often happen to elderly individuals due to osteoporosis and weakened bones; in fact, the proximal humerus bone in the shoulder is the third most frequently broken bone (after hip fractures and wrist fractures) in patients over 65 years old. The combination of age, potential osteoporosis or weakened bones, and. Interventions for Proximal Humerus Fractures Strengthening Exercise: started once fracture union is seen Deltoid and Rotator Cuff Isometrics Scapular stabilization exercises Scapular retraction, low trap setting, rhythmic stabilization, rows Active exercises starting supine and then moving to seated/standin Treatment: Open Fracture • Antibiotic therapy with urgent I&D Provisional internal fixation of articular surface to shaft 3. Application of contoured plates in buttress fashion (no - consecutive series of distal humeral fractures treated with ORIF and anterior ulnar nerv 10.1055/b-0040-176963 22 Humeral Shaft FracturesLisa K. Cannada and Ugochi Okoroafor Introduction Humeral shaft fractures comprise approximately 3% of extremity fractures and 20% of humerus fractures. This chapter will explore the indications for nonoperative versus operative management of humerus fractures. Several surgical approaches are described in detail A fracture of the humeral shaft in a child younger than 18 months has a high Often, these fractures occur during physical therapy and range-of-motion exercises. some authors suggest that these views be included in the imaging protocol. 114 Fractures may be missed if the guidelines are not followed or if the images are of poor quality.
Femur shaft fractures occur in high energy trauma such as motor vehicle accidents and falls . from a height. Gunshot and blast injuries also cause severe open fractures of this area. Lower energy accidents which may cause a fracture of the thigh bone include collisions in sports, skiing injuries and twisting injuries Adapted for patients of OrthoBalance PT from Move Forward; American Physical Therapy Association Physical Therapist's Guide to Femur Fracture A femur fracture is a break, crack, or crush injury of the thigh bone. It is sometimes referred to as a hip fracture; or broken hip if the break is in the upper part of the bone near the hip-joint area Proximal Humerus Fracture Non op. Proximal Humerus ORIF PT. Reverse Total Shoulder PT. Rotator Cuff Repair PT. SLAP Repair PT. SLAPODESIS Repair PT. Sternoclavicular Joint Reconstruction PT. Subacromial Decompression or Distal Clavicle Excision PT. Superior Capsule Reconstruction PT The humeral shaft is surrounded by large arm muscles, blood vessels and include the following: Posterior compartment: A fracture that occurs at the midshaft of the humerus usually occurs due to a direct blow to the upper arm. Most frequently, fractures are a result of trauma, such as a fall, motor vehicle accident, or motorcycle accident FEMORAL SHAFT FRACTURE P.T. PROTOCOL. gentle range of motion exercise in hip, knee, and ankle and focus in knee extension. initiation of weight bearing as tolerated ambulationwith either a walker B/L crutch. Following discharge from the hospital patient utilized a toe touch to 25% weight bearing status. 1. Modalities such as Faradic stimulation
A broken humerus takes around 6 weeks to heal, although it can take up to 1 year to recover after treatment. When an individual experiences a broken humerus, the arm should be supported in a manner that will pull down the humerus, which helps the fractured bone heal correctly Ohio State physicians and physical therapists work collaboratively to develop best clinical practices for post-surgical rehabilitation. The path to regaining range of motion, strength and function can require a sustained and coordinated effort from the patient, his or her family, the Ohio State Sports Medicine physical therapy team and sometimes, other healthcare providers Proximal humerus fractures will heal, typically within 6-12 weeks, even if the humerus is broken into two parts. Recovery can take up to six months, occasionally longer, for your symptoms to settle completely. Do I need any tests to confirm the diagnosis? If it is suspected that you have a proximal humerus fracture an x-ray and clinical.
The humerus, or upper arm is the second largest bone in the human body. Fractures of this bone can be divided in to three types, • The humeral head, which forms the ball of the shoulder joint. • The shaft. • The top part of the elbow joint. Your doctor will explain to you where in the humerus your fracture is. Fracture Treatmen Treatment for a fractured humerus usually involves immobilization in a collar and cuff or a cast for six to eight weeks, depending on the severity of the injury. Physical therapy exercises during the active recovery stage help you regain range of motion, strength and functioning in your arm and shoulder Therapy protocols recommended by Orthopedics & Sports Medicine BayCare Clinic specialists for shoulder, knee, hip, leg, foot, ankle, elbow or hand surgery. Listed below are physical therapy (PT) protocols categorized by physician. Distal Humerus Fracture ORIF. Distal Radius Fracture Casting fractures and ligament injuries. Associated in-juries include coronoid fractures, distal humerus articular shear fractures, Monteggia's fractures, and disruption of the collateral ligaments, inter-osseous ligaments, or both [1-3]. Although a consensus has emerged that favors the nonsurgical treatment of undisplaced fractures
Humeral shaft fractures are common injuries representing 3-5% of all fractures and occur at an incidence of approximately 15 per 100,000 per year. it is the author's protocol to internally. Distal humerus fractures are generally considered to occur in one of three types: complete extra-articular, partial intra-articular, or complete intra-articular (Figure 20.1). A complete extra-articular fracture involves the distal humeral shaft and variable portions of the columns, but spares the articular surface
The Neer classification for proximal humerus fractures is based on 4 fracture parts: the greater tuberosity, the lesser tuberosity, the humeral head, and the humeral shaft. A full description of the classification and its subtypes can be found in an article by Carofino and Leopold. 17 For practical purposes, fractures are discussed based on the. Midshaft Humerus fractures. Fractures of the humeral shaft are fairly common. Elderly patients with weaker bone can break their arm with relatively low levels of force (e.g. a simple fall) , but younger patients tend to require powerful twisting or bending forces to break their humerus physical therapy after humerus fracture A 25-year-old male asked: mid shaft humerus fracture an plated in arm how much time bone will take to cure an when should physio therapy started. angulation of plate also there
Orthopedic Goals 1. to obtain stability at the fracture site either by external or internal fixation, immobilization. 2. to prevent infection. 3. to reduce displaced fragment if any. 4. to obtain neck shaft angle of 130-150 degree and retroversion angle of 30 degree (proximal humeral #) 3. Rehabilitation Goals 1 A physical therapy program after a proximal humeral fracture can help you return to normal activity quickly and safely. Symptoms The symptoms of a proximal humeral fracture can vary by the location of the fracture, the complexity of the fracture, and your general health In case of closed humeral fracture, the humerus may get cracked or might get broken but is not exposed. The recovery period for most of the closed humeral fractures is usually between six to eight weeks. The treatment of closed humeral fractures can be both surgical as well as non-surgical. Know the cuases, symptoms, treatment, prognosis, recovery period and complications of closed humeral. Proximal Humerus Fracture Nonunion and Malunion are common complications associated with proximal humerus fractures which can lead to persistent shoulder pain, instability, and restricted motion. Diagnosis is made radiographically with shoulder radiographs demonstrating malposition of the humeral tuberosities, varus/vaglus head-shaft angulation.
Protocols, or guidelines, for physical therapy following a humerus fracture vary according If you're recovering from a Proximal Humeral Fracture, the specific protocol used by your physical therapist depends on factors that include the precise location Polarus 3 Solution offers two plate options - Standard and Posterior, as well as two Physical Therapy in Corpus Christi for Elbow Fractures. Welcome to Humpal Physical Therapy & Sports Medicine Centers patient guide on elbow fractures. The elbow is a very important region of the arm. It serves as a hinge joint between the upper and lower parts of the arm and allows movements for activities like feeding and lifting Introduction. Most humeral shaft fractures heal uneventfully whether treated nonoperatively or operatively , , .However, nonunion may occur resulting in pain and impaired function of the upper extremity that can be debilitating to the patient [4,5].Nonunions of the humeral shaft should be treated operatively to relieve pain and instability and restore function Background. Greater Tuberosity Fractures are a unique type of proximal humerus fractures. Although some people refer to them as shoulder fractures, we prefer to avoid that term as there are many bones around the shoulder.Greater Tuberosity Fractures may occur due to trauma or shoulder dislocation, and represent a boney disruption to the rotator cuff tendons around the shoulder i. Buckle fractures of the distal radius are one of the most common fractures of childhood and represent about 20% of all pediatric fractures4 ii. These fractures typically occur in the distal radius after longitudinal trauma along the shaft of the bone, i.e. fall on an outstretched hand iii Fracture fragments. One part Fracture (80% of Proximal Humerus Fractures) Less than 1 cm displacement. Less than 45 degree angulation. Two part Fracture s. Surgical neck Fracture (Most common 2-part) Distal to lesser tuberosity. Humeral Head Fracture (Anatomic neck Fracture) Greater tuberosity Fracture