Journal of hand therapy : official journal of the American Society of Hand Therapists
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This article presents early controlled mobilization options for potentially unstable, nondisplaced, nonarticular hand fractures. Early controlled mobilization of tissues surrounding a healing fracture has the potential to enhance the quality and rate of fracture healing and a person's functional recovery. The options discussed protect the integrity of the fracture alignment, while permitting safe, pain-free protected motion of joints adjacent to the fracture. ⋯ If clinically unstable, the fracture often is considered unable to tolerate unrestricted active motion during the initial stages of healing. This article offers an alternative perspective, in which clinicians can consider the clinical factors that can be controlled to allow for early protected motion of the regional tissues surrounding a potentially unstable hand fracture. These additional clinical options offer an alternative to acute fracture immobilization and help progress the rehabilitation of hand fracture patients.
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Review
Fracture healing: bone healing, fracture management, and current concepts related to the hand.
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. ⋯ 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.
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Proximal interphalangeal joint (PIP) injuries are among the most common in the hand and their severity is often underestimated. These injuries often lead to prolonged disability, pain, and stiffness. ⋯ Such an approach should lead to a rational treatment plan that focuses on the rehabilitation of all damaged components, including osseous, articular, and soft tissue structures. This article reviews all elements in the management of PIP injuries and introduces an assessment method for PIP injuries based on the mechanism of injury rather than primarily on the basis of radiographic findings.
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This article addresses current approaches for the rehabilitation of distal phalanx and middle phalanx fractures, excluding proximal interphalangeal joint avulsion fractures. Emphasis is placed on establishing the optimal rehabilitation program based on an understanding of the type and location of the fracture, method of fracture management, fracture stability, fracture healing, complications from soft tissue injuries, and recognizing and preventing common problems associated with fractures. Patient case examples and results reported in the literature are included.
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A better understanding of the biology of fracture healing and an increasing awareness of the limitations and potential complications of autogenous bone graft harvest have combined to foster a burgeoning interest in the development of bone graft substitutes. A few of these materials have been available for more than a decade, and many more should become available in the near future. The characteristics of the ideal bone graft substitute may vary considerably depending on the intended site of application and the clinical setting in which it is used. Knowledge of the available alternatives is a necessary prerequisite to informed decision making.