Orthotic Management of Fracture

Definition
Fracture is a break of continuity of bone or cartilage or both, as a result of excessive application of force to the bone

Causes
a. direct violence
• Application of stress beyond the limits of strength of a bone. In this type of injury the skin may be broken by the external force of the object onto the skin, not the fracture breaking the skin from within.
• Another mechanism for direct fractures where the body strikes an object
b. Indirect violence
• a twisting or bending force may be applied to a bone, which result in a fracture

Signs & Symptoms
• Pain and swelling at the fracture site
• Tenderness close to the fracture
• function of an extremity may not be able to be performed
• tingling, numbness or paralysis in areas below the fracture if nerves injured
• the extremity may appear pale and without a pulse if an artery has been damaged

Complications
a. Fibrous union
b. Non-union
c. Delayed union.

Fracture management
a. Reduction of the fracture: by alignment
b. Immobilization of reduced fracture until healing is complete
Principles of Fracture cast bracing
a. Immobilize the fracture site while allowing movement at adjacent joints.
b. Control the fracture site by incorporating soft tissue containment
c. Reduce rehabilitation time by maintaining joint ROM and muscle strength
d. Accommodate volume change (reduce swelling or increase muscle bulk) while maintaining control over the fracture
e. Allow access to the skin when required by providing a removable fracture orthosis

Type of Fracture orthoses

a. Non Removable
Once applied, can be removed by only qualified person with appropriate equipment. It needs to be reviewed on a regular basis, as they are not adjustable for volume fluctuations. They are also prone to breakdown and should be appropriately protected from damage. Example: POP Bandages cast boot

b. Removable
The orthosis is applied with a mechanism for removal and adjustment. The orthosis therefore adjustable and may be removed for reasons of hygiene, wound viewing, etc. Its enable volume adjustment as inflammation and swelling subside.
Example: Tibial Fracture brace, Humerus Fracture Brace, Scaphoid Fracture.
It is depend on the location and severity of the fractures.

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