Schatzker Classification
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
Treatment Goals
Orthopaedic Objectives
Alignment
Prevent varus / valgus deformity
Prevent Instability
Prevent future degenerative changes
Stability
Bone Congruity restored
Rigidly Fixed
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
Treatment Goals
Rehabilitation Objectives
Range of Motion
Restore ROM of knee ASAP (prevent functional
disability)
Restore ROM Ankle and Hip
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
Treatment Goals
Rehabilitation Objectives
Muscle Strength
Functional Goals
Normalize the gait pattern and restore the stability of the
knee during stance phase
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
Treatment Goals
Expected Time of Bone Healing
10-12 weeks (8 weeks Type I)
Methods of Treatment
Hinged Orthosis
ORIF
External Fixation
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
Treatment Goals
Special Considerations of fracture
Age
Location (IV-VI)
Injured anatomy
Associated Injury
Weight Bearing
NWB 3 Mos
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
Treatment Goals
Gait Cycle
Foot Flat
No problem
Mid Stance
Full Weight Tibia plateau not smooth ~ antalgic gait ~ hop off
(reduce pain)
Push-off
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
Treatment
Early to Immediate (DOI 1 week)
Inflammatory phase
Orth & Rehab Consideration
PE: NVD, Ankle & Foot ROM, Compartement, Wound,
edema ~ elevation
Dangers: compartement synd, Drop foot, even minimal
displaced ~ future degenerative ~ work aggressively
Ro: Alignment , displacement
WB: NWB 3 Mos
ROM: early knee ROM (CPM, Active-Assistive), sitting
edge of seat~ 40-60 increasing 90 after 1 week
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
Treatment
Early to Immediate (DOI 1 week)
Orth & Rehab Consideration
Muscle Strength: (-), when pain subsides ~ ankle
isotonic w/o resisance, gluteal exercises (help from
sitting to standing)
Functional Activities: NWB
Gait: 2 point NWB using crutches
Crutch + Sick = Healthy
Stairs: up~ healthy 1st, down~sick 1st
Difficult to ambulate in NWB: Toe touch
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
Treatment
Early to Immediate (DOI 1 week)
Methods of Treatment: specific aspect
Hinged Orthosis: adequate fit with the knee
ORIF: + Hinged orthosis ~ knee 0-90, no strengthening
exercise, ankle isotonic ex + gluteal sets
Ex Fix: across knee no ROM
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
Treatment
Two Weeks
Reparative Phase (osteoprogenitor cells
Osteoblast for woven bone
Orth & Rehab Consideration
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
Treatment
Two Weeks
Orth & Rehab Consideration
Muscle strength: isometric exercises of Quadriceps at the
end of 2 weeks (prevent disuse artrophy)
Functional Activities: NWB
Gait: two-point NWB gait using crutches. Elderly Px ~ toetouch allowed while using walker
Treatment
Four - Six Weeks
Reparative phase, Bridging Callus, Stable (Confirm
with PE)
Orth & Rehab Consideration
PE: Wound, pain, parasthesia, CRT, Flexion knee ~90
Dangers: Fracture displacement, loss of fixation
Ro: loss of correction/displacement, varus/valgus
deformity
WB: NWB for 3 Mos
ROM: active & Active assisted ROM exercise (0-90),
incr. Freq & intensity, ankle & hip (+)
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
Treatment
Four - Six Weeks
Orth & Rehab Consideration
Muscle strength: continue isometric exercise of
Quadriceps + start of Hamstring + continue ankle
isotonics
Fucntional Activites: NWB
Gait: two-point NWB gait using crutches
Treatment
Eight - Twelve Weeks
Stable, early remodelling phase, woven lamellar,
fracture line starts disapperaring
Orth & Rehab Consideration
PE: Wound, pain, parasthesia, CRT, Flexion knee ~90
Dangers: Fracture displacement, loss of fixation
Ro: loss of correction/displacement, varus/valgus deformity,
callus, fracture line
WB: callus adequate + stable fracture + no collateral lig
tenderness/instabillity Partial Weight Bearing
ROM: active & Active assisted ROM exercise (0-90), incr.
Freq & intensity
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
Treatment
Eight - Twelve Weeks
Orth & Rehab Consideration
Muscle strength: Quadriceps + Hamstring + Ankle
Fucntional Activites: if callus is adequate end of 12th
weeks PWB
Gait: WB regular gait pattern
Treatment
Twelve to Sixteen Weeks
Stable, remodelling phase, woven lamellar,
Fracture line disappear
Orth & Rehab Consideration
PE: Wound, pain, parasthesia, CRT, Flexion knee ~90
Dangers: stiffness
Ro: loss of correction/displacement, varus/valgus
deformity, callus, fracture line & Callus
WB: FWB
ROM: full extension + at least 90 degree of Flexion
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
Treatment
Twelve to Sixteen Weeks
Orth & Rehab Consideration
Strength: Quadriceps + Hamstring, resistive excercise
increase progressively
Functional activities: weaned of assistive devices
Gait: normalizing gait
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
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