Frature management

[alophysio]

Hi Twilight,

Very difficult to answer these questions. No doubt you have tried to look up textbooks and found they tell you everything

Some very general prinicples are (and these are loose off the top of my head)
1. Support the fracture - this should be done in a cast usually but sometimes neck of humerus is difficult. Jull in the 80s produced some sort of protocol i think about mobilisation of these fractures.

2. If a muscle crosses the joint, then be careful with activating it strongly - such a general statement i know but this is a general question!

3. The principles of fracture management should be in textbooks - for instance, i just looked up Clinical Sports Medicine by Brukner and Kahn and it had many different fractures listed in the index and management for them. Otherwise, i usually sit there and think up what i want to do and then chat to someone about my ideas to make sure i am not off my head!

Perhaps some case studies??

[twilight]

Thanks Alo.
Yep, I myself feel the need for case studies here, i guess i didn't convey my doubt properly either. I had referred to books like brukner and atkinson, but wanted to get some idea from clinicans who see such cases as outpatients. So here's one: ( i hope i can do justice to it !!)

A young person with a surgical neck of humerus fracture, immobilized for 6 wks, cleared by his doctor as healed, comes to physio( first treatment session).
Lets say his AROM is not more than 100 deg in flx and abd and has typical hiking of shoulder and has limitation of int and ext rotation ( I don't really remember which movmnt wud be limited most in such a fracture but presume most movements wud be). His PROM say is limited at 110 degree of flxn and abd. . I assume the shoulder muscles would be weak as well. Lets say his pain levels are less and willing to participate well with physio ( the most ideal situation . No other previous problems with shoulder or other joints and no relevant past medical history.

I wanted to know what would be the ideal treatment of choice to improve ROM here. also any other things I have to think about while assessing?

cheers

[Dapy]

I would just be brief!
once you are okay that there are no Yellow flags (SIN- severity, irritability of pain and others), I woulg go for Mulligan technique (Mobilization with movement),
passively gliding the joint (arthrokinematic) with concave-convex rule in mind, then ask for active movement from the patient.You must see improvement immediately, once you achieve 50% of AROM, Graded Maitland technique cf 3 minus and 3 could be combined .You can compliment these with others adjunct treatment.