Podcast
Questions and Answers
During which stage of secondary healing in fractures is motion not eliminated across the fracture gap?
During which stage of secondary healing in fractures is motion not eliminated across the fracture gap?
What is the primary advantage of primary healing over secondary healing in fractures?
What is the primary advantage of primary healing over secondary healing in fractures?
When does the soft callus formed during the repair stage of fracture healing get converted into a hard callus?
When does the soft callus formed during the repair stage of fracture healing get converted into a hard callus?
Which phase of fracture healing is characterized by the development of a hematoma providing early stability?
Which phase of fracture healing is characterized by the development of a hematoma providing early stability?
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In primary healing, when should strengthening or overloading of muscle-tendon structures be delayed to?
In primary healing, when should strengthening or overloading of muscle-tendon structures be delayed to?
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What permits direct regrowth of bone across a fracture line in primary healing?
What permits direct regrowth of bone across a fracture line in primary healing?
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What is a common client complaint associated with Distal Phalanx Fractures?
What is a common client complaint associated with Distal Phalanx Fractures?
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Which type of fracture often involves more than 50% of the joint surface and typically requires traction?
Which type of fracture often involves more than 50% of the joint surface and typically requires traction?
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What is the recommended therapeutic program for Distal Phalanx Fractures once wound healing permits?
What is the recommended therapeutic program for Distal Phalanx Fractures once wound healing permits?
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What is a common treatment approach for most metacarpal fractures?
What is a common treatment approach for most metacarpal fractures?
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Which of the following is NOT a part of the desensitization program recommended for Distal Phalanx Fractures?
Which of the following is NOT a part of the desensitization program recommended for Distal Phalanx Fractures?
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What is the traditional treatment for stable minimally displaced metacarpal neck and shaft fractures?
What is the traditional treatment for stable minimally displaced metacarpal neck and shaft fractures?
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Which finger should all fingers converge toward in cases of metacarpal fractures?
Which finger should all fingers converge toward in cases of metacarpal fractures?
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For which type of fracture is buddy strapping recommended for 2 additional weeks post-splint?
For which type of fracture is buddy strapping recommended for 2 additional weeks post-splint?
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What is a common complication of P1 fractures that results in both flexion and extension limitations?
What is a common complication of P1 fractures that results in both flexion and extension limitations?
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What is the main cause of Middle Phalanx fractures?
What is the main cause of Middle Phalanx fractures?
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Involves over 30% to 50% of the joint surface and may dorsally subluxate the base of the middle phalanx describes which type of avulsion-fracture classification?
Involves over 30% to 50% of the joint surface and may dorsally subluxate the base of the middle phalanx describes which type of avulsion-fracture classification?
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'The PIPJ is the most commonly injured joint in the hand' refers to injuries related to which part of the hand?
'The PIPJ is the most commonly injured joint in the hand' refers to injuries related to which part of the hand?
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Study Notes
Fracture Healing
- Primary Healing: occurs when fixation methods provide compression and stability, allowing direct regrowth of bone across the fracture line
- Secondary Healing: occurs when motion is not eliminated across the fracture gap, resulting in a fibrous callus repair phase later converted into bone
- Stages of Fracture Healing:
- Inflammatory Stage (5-7 days): characterized by hematoma formation, growth factor release, and early stability
- Repair Stage: hematoma is replaced with a gradually forming soft callus, converted into a hard callus (early bone)
- Remodelling Stage: angiogenesis, osteogenesis, and remodeling
Primary Healing
- Faster union compared to secondary healing
- Advantages: precise anatomical reduction, avoidance of peripheral callus, and immediate initiation of post-operative motion
- Important note: strengthening or overloading muscletendon structures must be delayed to similar timeframes as per secondary healing
Distal Phalanx Fractures
- Most commonly associated with crush injuries
- Hypersensitivity is a common client complaint
- Do not require immobilization, but often splinted for protection
- Therapeutic considerations: initiate desensitization program as soon as wound healing permits
Metacarpal Fractures
- Represent 30-35% of hand fractures
- More stable than phalangeal fractures
- Usually involve the neck
- Commonly caused by fight or fall
- 4th and 5th metacarpals are most often involved
- Importance of proper splint positioning: MCPJ flexion, MCPJ extension
- Treatment: orthosis/cast (ulnar or radial gutter), MCPJ immobilized in 70 degrees of flexion, IP's within splint to allow full flexion and extension for 3-4 weeks
- Strengthening beginning at 6 weeks
Metacarpal Fractures: Hand Therapy Following ORIF
- Referred to hand therapy within 72 hours
- Orthotic application (volar vs dorsal)
- Wrist in extension, MCPJ's flexed, and the IPJ's extended
- Edema control and AROM
- Intrinsic minus, intrinsic plus, isolated FDS, EDC gliding, and isolated FDP
Proximal Phalanx Fractures
- Represent 15-20% of hand fractures
- Usually proximal or mid-shaft level
- More unstable than metacarpal fractures
- Respond unfavorably to immobilization
- Functional outcome related to severity of injury: open fractures, comminuted fractures, and associated soft tissue injuries
- Treatment considerations: edema draws the PIPJ into a predictable pattern of deformity, ROM initiation, and coban application
P1 Fractures: Complications
- PIPJ extension lag
- PIPJ flexion contracture with pseudoclawing
- FDS and FDP adherence
- Limitations in both flexion and extension
- Treatment priorities: which motion is most functionally limiting, and which motion is most difficult to attain
Middle Phalanx Fractures
- Occur with less frequency (8-12%)
- Main cause: crush injury
- Distal portion mostly common involved
- P2 Fractures: common # - Volar Plate-Avulsion-#
- Avulsion-Fracture Classification: Type 1, Type 2, and Type 3
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Description
Learn about the stages of fracture healing process, including Primary Healing and Secondary Healing. Explore the Inflammatory Stage, Repair Stage, and Remodelling Stage of fracture healing.
