Bones fracture frequently and often result in significant impairments, functional limitations, an... more Bones fracture frequently and often result in significant impairments, functional limitations, and disabilities, especially when the hand is involved. When fractures occur, there is a disruption of the skeletal tissue organization and a loss of mechanical integrity. The goal of fracture healing is to regenerate mineralized tissue in the fracture area and restore mechanical strength to the bone. Of equal importance is the reconstitution of the normal soft tissue gliding and movement about the fracture site. This article briefly reviews the history of fracture healing and the advances in mechanics and cellular and molecular biology, which should help the reader better understand the current mechanisms related to bone healing (primarily and secondarily). Fracture fixation modes also are described along with the temporal sequencing as to when to protect or move the fractured region.
Proximal phalangeal fracture stability is crucial for the initiation of early and effective exerc... more Proximal phalangeal fracture stability is crucial for the initiation of early and effective exercises designed to recover digital and especially proximal interphalangeal joint motion. Active digital flexion and extension exercises are implemented by synergistic wrist motion. Joint blocking exercises and active tendon gliding exercises in protective blocking splints are instrumental elements of early treatment. Dynamic splinting and serial finger casting are used in recalcitrant, severe, and late presenting cases. Surgical release is a last resort in regaining proximal interphalangeal joint motion. This measure is reserved for a failure of treatment when residual proximal interphalangeal joint contracture is persistent and severe enough to cause serious impairment of digital motion and hand function.
We have presented a new method of dynamic splinting that allows a greater range of protected moti... more We have presented a new method of dynamic splinting that allows a greater range of protected motion under constant tension. The device has been designed for use with newer methods of tendon repair in situtations where early controlled motion is allowed.
Scar, our body's "glue," is formed through a highly organized sequence of physiolog... more Scar, our body's "glue," is formed through a highly organized sequence of physiologic events. The ability of one type of collagenous tissue to weld various tissues, adapt to their structural integrity, impart tensile strength, and permit return of function is reviewed. A knowledge of wound healing enables the clinician to design and implement treatment strategies based on scar biology. The purposes of this overview are 1) to address the three phases of repair (inflammatory, fibroplastic, and remodeling), 2) to discuss the cellular processes occurring in each phase, 3) to review appropriate intervention methods based on research findings, and 4) to describe complications that interfere with normal healing.
Journal of Orthopaedic & Sports Physical Therapy, 2004
Patients with common hand fractures are likely to present in a wide variety of outpatient orthope... more Patients with common hand fractures are likely to present in a wide variety of outpatient orthopedic practices. Successful rehabilitation of hand fractures addresses the need to (1) maintain fracture stability for bone healing, (2) introduce soft tissue mobilization for soft tissue integrity, and (3) remodel any restrictive scar from injury or surgery. It is important to recognize the intimate relationship of these 3 tissues (bone, soft tissue, and scar) when treating hand fractures. Fracture terminology precisely defines fracture type, location, and management strategy for hand fractures. These terms are reviewed, with emphasis on their operational definitions, as they relate to the course of therapy. The progression of motion protocols is dependent on the type of fracture healing, either primary or secondary, which in turn is determined by the method of fracture fixation. Current closed-and open-fixation methods for metacarpal and phalangeal fractures are addressed for each fracture location. The potential soft tissue problems that are often associated with each type of fracture are explained, with preventative methods of splinting and treatment. A comprehensive literature review is provided to compare evidence for practice in managing the variety of fracture patterns associated with metacarpal and phalangeal fractures, following closedand open-fixation techniques. Emphasis is placed on initial hand positioning to protect the fracture reduction, exercise to maintain or regain joint range of motion, and specific tendon-gliding exercises to prevent restrictive adhesions, all of which are necessary to assure return of function post fracture.
C onnective tissue requires motion to maintain its structural integrity. Motion, with its demands... more C onnective tissue requires motion to maintain its structural integrity. Motion, with its demands for tissue elongation, shortening, and support, creates the necessary stresses for normal fiber biology. Biologic tissues respond to these stress signals by changing their collagen matrix to meet the functional demands of motion. The connective tissue matrix is made up of structural fibers such as collagen, elastin, and fibrin, which are held together by chemical bonds and a fluid ground substance. The weave or alignment of these structural fibers can be classified as either dense or loose packed. Dense connective tissue that functions to support or limit motion, such as bone, ligament, and tendons, has parallel, tightly aligned fibers. When tension is applied to dense connective tissue, there is initial lengthening until all slack has been taken up, followed by gradual stretch or elongation, after which fiber disruption occurs.l Conversely, loose connective tissue, such as that found in joint capsules, muscle, fascia, and skin, contributes to flexibility through its random fiber orientation. This loose weave allows great lengthening without tension buildup until all the fibers have been essentially straightened. 2 Both types of tissues, dense and loose, have a filler gel that acts to separate and lubricate the collagen fibers. This mucopolysaccharide gel combined with water forms a ground substance that varies from low concentration in dense tissue to high concentration in loose tissue. 3 The two factors of fiber orientation and ground substance ratio, although unique to each tissue, are very dynamic and
Scar, our body's “glue,” is formed through a highly organized sequence of physiologic events... more Scar, our body's “glue,” is formed through a highly organized sequence of physiologic events. The ability of one type of collagenous tissue to weld various tissues, adapt to their structural integrity, impart tensile strength, and permit return of function is ...
Bones fracture frequently and often result in significant impairments, functional limitations, an... more Bones fracture frequently and often result in significant impairments, functional limitations, and disabilities, especially when the hand is involved. When fractures occur, there is a disruption of the skeletal tissue organization and a loss of mechanical integrity. The goal of fracture healing is to regenerate mineralized tissue in the fracture area and restore mechanical strength to the bone. Of equal importance is the reconstitution of the normal soft tissue gliding and movement about the fracture site. This article briefly reviews the history of fracture healing and the advances in mechanics and cellular and molecular biology, which should help the reader better understand the current mechanisms related to bone healing (primarily and secondarily). Fracture fixation modes also are described along with the temporal sequencing as to when to protect or move the fractured region.
Proximal phalangeal fracture stability is crucial for the initiation of early and effective exerc... more Proximal phalangeal fracture stability is crucial for the initiation of early and effective exercises designed to recover digital and especially proximal interphalangeal joint motion. Active digital flexion and extension exercises are implemented by synergistic wrist motion. Joint blocking exercises and active tendon gliding exercises in protective blocking splints are instrumental elements of early treatment. Dynamic splinting and serial finger casting are used in recalcitrant, severe, and late presenting cases. Surgical release is a last resort in regaining proximal interphalangeal joint motion. This measure is reserved for a failure of treatment when residual proximal interphalangeal joint contracture is persistent and severe enough to cause serious impairment of digital motion and hand function.
We have presented a new method of dynamic splinting that allows a greater range of protected moti... more We have presented a new method of dynamic splinting that allows a greater range of protected motion under constant tension. The device has been designed for use with newer methods of tendon repair in situtations where early controlled motion is allowed.
Scar, our body's "glue," is formed through a highly organized sequence of physiolog... more Scar, our body's "glue," is formed through a highly organized sequence of physiologic events. The ability of one type of collagenous tissue to weld various tissues, adapt to their structural integrity, impart tensile strength, and permit return of function is reviewed. A knowledge of wound healing enables the clinician to design and implement treatment strategies based on scar biology. The purposes of this overview are 1) to address the three phases of repair (inflammatory, fibroplastic, and remodeling), 2) to discuss the cellular processes occurring in each phase, 3) to review appropriate intervention methods based on research findings, and 4) to describe complications that interfere with normal healing.
Journal of Orthopaedic & Sports Physical Therapy, 2004
Patients with common hand fractures are likely to present in a wide variety of outpatient orthope... more Patients with common hand fractures are likely to present in a wide variety of outpatient orthopedic practices. Successful rehabilitation of hand fractures addresses the need to (1) maintain fracture stability for bone healing, (2) introduce soft tissue mobilization for soft tissue integrity, and (3) remodel any restrictive scar from injury or surgery. It is important to recognize the intimate relationship of these 3 tissues (bone, soft tissue, and scar) when treating hand fractures. Fracture terminology precisely defines fracture type, location, and management strategy for hand fractures. These terms are reviewed, with emphasis on their operational definitions, as they relate to the course of therapy. The progression of motion protocols is dependent on the type of fracture healing, either primary or secondary, which in turn is determined by the method of fracture fixation. Current closed-and open-fixation methods for metacarpal and phalangeal fractures are addressed for each fracture location. The potential soft tissue problems that are often associated with each type of fracture are explained, with preventative methods of splinting and treatment. A comprehensive literature review is provided to compare evidence for practice in managing the variety of fracture patterns associated with metacarpal and phalangeal fractures, following closedand open-fixation techniques. Emphasis is placed on initial hand positioning to protect the fracture reduction, exercise to maintain or regain joint range of motion, and specific tendon-gliding exercises to prevent restrictive adhesions, all of which are necessary to assure return of function post fracture.
C onnective tissue requires motion to maintain its structural integrity. Motion, with its demands... more C onnective tissue requires motion to maintain its structural integrity. Motion, with its demands for tissue elongation, shortening, and support, creates the necessary stresses for normal fiber biology. Biologic tissues respond to these stress signals by changing their collagen matrix to meet the functional demands of motion. The connective tissue matrix is made up of structural fibers such as collagen, elastin, and fibrin, which are held together by chemical bonds and a fluid ground substance. The weave or alignment of these structural fibers can be classified as either dense or loose packed. Dense connective tissue that functions to support or limit motion, such as bone, ligament, and tendons, has parallel, tightly aligned fibers. When tension is applied to dense connective tissue, there is initial lengthening until all slack has been taken up, followed by gradual stretch or elongation, after which fiber disruption occurs.l Conversely, loose connective tissue, such as that found in joint capsules, muscle, fascia, and skin, contributes to flexibility through its random fiber orientation. This loose weave allows great lengthening without tension buildup until all the fibers have been essentially straightened. 2 Both types of tissues, dense and loose, have a filler gel that acts to separate and lubricate the collagen fibers. This mucopolysaccharide gel combined with water forms a ground substance that varies from low concentration in dense tissue to high concentration in loose tissue. 3 The two factors of fiber orientation and ground substance ratio, although unique to each tissue, are very dynamic and
Scar, our body's “glue,” is formed through a highly organized sequence of physiologic events... more Scar, our body's “glue,” is formed through a highly organized sequence of physiologic events. The ability of one type of collagenous tissue to weld various tissues, adapt to their structural integrity, impart tensile strength, and permit return of function is ...
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