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Physiotherapy for fractures



What is a fracture?



A fracture and a break have the same definition. The word fracture is the orthopaedic medical term for a break in the bones continuity. There are many injury mechanisms for fracture occurrence and some people can be at a greater risk of developing a fracture, such as those who have osteoporosis. Fractures can be classified into groups dependent upon the type of fracture. A fracture will get two classifications, firstly the type of fracture and secondly a classification informing of the amount of soft tissue damage. This is known as the Tscherne Classification.

How are fractures classified?



Fractures can be classified on the type and severity of break within the bones continuity. The classifications are:
  • Open – this is where the bone has pierced the skin and is exposed to outside environments.
  • Closed – this is where the bone has not pierced the skin.
The fracture is then classified into:
  • Simple – two bone fragments
  • Wedge – wedge segment of bone fractured
  • Complex – many fragments of bone
  • Spiral – the fracture spirals down the length of the bone
  • Oblique – the fracture is along an oblique line to the bones axis
  • Transverse – the fracture is n the transverse plane to the bones axis
  • Avulsion – a segment of the bone is completely detached
  • Compression – where two bones are forced together (usually in the spine)
  • Green stick – usually found during infancy where the bones are still softer. The bone bends causing the outside edge of the bone to fracture.
Tscherne Classification
  • Grade 0 – minimal soft tissue damage
  • Grade 1 – superficial bruising and contusions
  • Grade 2 – extensive soft tissue damage, muscle contusions and skin abrasions
  • Grade 3 – severe soft tissue injury, destruction of tissue, muscle and vascular structures

Paediatric complications of fractures



Complications can arise after a child fractures a bone. If the fracture site is close to a growth plate then damage may have occurred. This can lead to an early closure of the growth plate, resulting in the bone not growing to its intended length.

Surgical treatment or Conservative treatment



There are predominately two ways to manage fractures which are:
  • Surgically – this is where the orthopaedic medical team operate on the fracture site and use pins and plates to stabilise and realign the bones. One of the procedures is called Open Reduction Internal Fixation (ORIF). The surgeons can also perform a procedure call a Manipulation Under Anaesthesia (MUA), where the fracture does not need pins and plates to hold the site together it just needs to be realigned and conservatively managed post MUA. A course of Physiotherapy is essential to fully rehabilitate the injury site post surgical intervention.
  • Conservatively - this is where the orthopaedic medical team decide that the fracture site is not displaced enough to reason the need for surgical intervention and immobilisation with a course of physiotherapy is the desired management.
Both management strategies of fractures will require an element of Physiotherapy input to facilitate a speedy and full recovery throughout the stages of healing.

Please contact us or call 0161 883 0077 to arrange an appointment.

Stages of Healing



There are 5 main stages of fracture healing. They are listed below explaining how Physiotherapy can assist at which stage:

Stage 1: Haematoma formation (one – two days)

Stage 2: Inflammation process (one-five days)
Physiotherapy can give advice and assist speed the inflammation process using different treatments which could include electrotherapy. Due to the early stage of the healing process the fracture will usually be immobilised for several weeks, therefore limiting treatment.

Stage 3: Soft Callus formation and dead tissue removal (four days – three weeks)
The plaster cast may be removed to the later period of this stage. Physiotherapy can again aid deal with swelling and pain through electrotherapy, such as LIPUS to stimulate bone regeneration.

Stage 4: Hard Callus formation, bone is re-united (two – twelve weeks)
Physiotherapy is essential at this stage as the plaster cast will be removed and the rehabilitation process of the fracture site can begin. Physiotherapy may include the following techniques:
  • Range of movement exercises – to restore normal movement at the joint.
  • Joint mobilisations – to increase the range of movement t the joint and decrease pain.
  • Electrotherapy (LIPUS, PSWD, Interferential, TENS)
  • Balance Exercises
  • Proprioceptive Exercise
  • Strengthening Exercises
  • Core Stability Exercises
  • Massage
Stage 5: Remodelling process is where the bone forms the shape it originally was and the tissue density becomes stronger (can take up to several years) Physiotherapy is also important at this stage of the rehabilitation process as weight bearing and more advanced exercises promote bone density and strength. This again will be done through physiotherapy modalities mentioned previously.

How Physiotherapy helps



Physiotherapy after a fracture is a key stage of the rehabilitation process. Physiotherapy helps with the following:
  • Speeds recovery time
  • Increases the strength as close to baseline as possible
  • Restores normal movement to assist with activities of daily living
  • Enhance independence
  • Return to sport quicker
  • Improve self-confidence in the injury
  • Decrease pain
  • Provide self-management strategies

Summary



Fractures can be complicated injuries which can cause lasting deliberating effects without the correct rehabilitation. The healing process is a long one where Physiotherapy interventions can be beneficial for the individual. Manchester Physio has experience qualified Physiotherapists who have aided the rehabilitation of many people with different fractures. Please contact us or call 0161 883 0077 to arrange an appointment.

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