Case Presentation on Fracture & its Healing Process This PPT includes a case study of a patient with a fracture and the process and techniques are implemented to improve the healing.

1. CASE PRESENTATION
BY
S. CHRISTY SOPNA (BPT.)

2. FRACTURE
! Fracture is the break or crack in the continuity of the bone caused by
fall or accident .
! PHASES OF FRACTURE HEALING
phase Name of phase Timeframe
1 inflammatory 0-14 days
2 reparative 0-2 days
3 Proliferative,fibroplastic 2-5 days
4 regenerative 4-21 days
5 remodeling 21-360 days

3. CASE STUDY
A 20 year male patient with the elbow cast till wrist and with dynamic cock up
splint. He had a fall on From the bike which was idle with a side stand,
unfortunately the stand Submerged suddenly into the soil and he fell down by his
left side and got swelling and severe pain and admitted in the hospital, from the x-
ray found that the patient had closed displaced fracture in radial head and left
distal end radius with left elbow dislocation. The patient had left compartmental
syndrome and undergone fasciotomy with closed reduction and internal fixation
(CRIF) with k-wire of distal radius with radial head extraction and ulnohumeral
pinning on 27/7/19. The patient also undergone split skin graft on 9/8/19.

4. X-RAYS

5. ELBOW
DISLOCATION

6. Distal radius fracture

7. Radial head fracture

8. Closed reduction internal
fixation with K-Wire of
distal radius

9. Ulnohumeral
pinning
Radial head extraction

10. On observation
❖ Patient is on cast with elbow flexed to 90 degree till wrist
❖ Patient is on dynamic cock up splint
❖ Patient has flexion at MCP joint and reduced movements in the index and
thumb finger.
❖ The patient is on DYNAMIC COCK UP SPLINT from 17/8/19.
❖ The patient is on cast from elbow to forearm
❖ Scar seen on both thigh due to the skin graft taken
❖ The skin is peeling and dry in the palm .
❖ Attitude of limb:ebow in 90 degree forearm in neutral thumb is adduction
and all the four fingers r 90degree in PIP and 90 degree in DIP.

11. On palpation
❖ The skin is warm in the medial 2 ½ fingers and cold in the lateral 2
½ fingers.
❖ Skin is rough and peeling of skin.
❖ Capillary filling time is more than 3 secs in index finger and 3 secs
in all other fingers.

12. On movements
❖ Difficulty in moving the thumb in flexion, opposition of thumb actively.
❖ Unable to perform the flexion of MCP, PIP and DIP of index finger.
❖ There is a reduced sensation both pinrick and soft touch in the middle
and index finger

13. On examination
Sensory assessment
1st week 2nd week

14. Dorsal aspect of hand
There is a reduced sensation
in the middle and the index
finger in the dorsal aspect in
the 1st and 2nd week

15. Motor examination
Joint Little finger
V
Ring finger
IV
Middle finger
III
Index finger
II
MCP
Flexion 20 °. 30 ° 40 ° 20 °
Extension 5 ° 5 ° 20 ° 0 °
PIP flexion 30 ° 60 ° 40 ° 0 °
Extension 0 ° 60-5 ° 40 °-10 ° 0 °
DIP flexion 60 ° 70 ° 70 ° 0 °
Extension 0 ° 70 °-10 ° 70 °-10 ° 0 °
RANGE OF MOTION 1st Week

16. JOINTS Little finger
V
Ring finger
IV
Middle finger
III
Index finger
II
MCP
Flexion 45 ° 40 ° 40 ° 35 °
Extension 45 °-0 ° 40 °-0 ° 40 °-0 ° 35 °-0 °
PIP flexion 60 ° 65 ° 65 ° 0 °
Extension 0 ° 0 ° 0 ° 0 °
DIP flexion 90 ° 90 ° 90 ° 0 °
Extension 0 ° 0 ° 0 ° 0 °
2nd week
RANGE OF MOTION

17. Thumb I Range
MCP
Flexion 30°
Extension 30°-0°
Abduction 0°
Adduction 0°
DIP flexion 0°
extension 0°
Thumb I Range
MCP
Flexion 40°
Extension 0°
Abduction 10°
Adduction 10°-0°
DIP flexion 0°
extension 0°
1st week 2nd week

18. Muscle power
MUSCLES Little finger
V
Ring finger
IV
Middle finger
III
Index finger
II
FDP 3+ 3+ 2 0
FDS MCP
PIP
4
4
4
4
2
3
0
0
Palmar
interossei
3 3 2 2
Dorsal
interossei
3 3 2 2
Lumbricals 3 3 2 1
Extensor 3 3+ 3+ 3+
FDP-flexor
digitorum
profundus
FDS-flexor
digitorum
superficialis
1st Week

19. MUSCLES Little finger
V
Ring finger
IV
Middle finger
III
Index finger
II
FDP 5 5 5 1
FDS MCP
PIP
5
5
5
5
5
5
2
1
Palmar
interossei
5 5 5 4
Dorsal
interossei
5 5 1 1
Lumbricals 5 5 3 3
Extensor 5 5 5 4
2nd Week

20. MUSCLES I WEEK II WEEK
Flexor pollicis brevis 0 1
Flexor pollicis longus 0 1
Opponens pollicis 1 3
Abductor pollicis brevis 1 2
Adductor pollicis brevis 5 5
Extensor pollicis longus 5 5
Extensor pollicis brevis 5 5
MUSCLE POWER OF THUMB

21. PHYSIOTHERAPEUTIC MANAGEMENT
GOALS TREATMENT
➢ To increase the ROM of fingers
➢
➢
➢
➢ To increase ROM of wrist
Active assisted
Active
Resisted range of motion exercises to
the fingers
Active ROM exercises to wrist
➢ To increase the muscle power Strengthening exercise
Place and hold exercises
Resisted exercise to the weak muscles
Hold and relax
➢ To increase the tendon movements Tendon gliding exercises
➢ To increase the functional activity
of the patient
Gripping and grasping activities
➢ To reduce swelling Exercises r done by hand elevated

22. Tendon gliding exercises Gripping activities

23. Functional assessment

24. Functional scaling
Upper extremity Day of removal of
pop
1st week 2nd week
Functional scale 21/80 30/80 38/80

25. Thank you