Fracture Management for the Hand and Upper Limb Therapist

Goals & Objectives:

Course Goals:

Fracture management is constantly evolving as new therapy techniques are developed and surgical stabilization methods change. University curriculum rarely provides up-to-date training in management of upper extremity (UE) fractures.  This course prepares the beginning and intermediate therapist to successfully treat patients with upper extremity fractures and associated injuries using current research and case studies.  This course presents the physiology of bone healing, reviews relevant anatomy, explains pathology using models and x-rays, and describes surgical procedures and therapy protocols currently in use to lay a foundation for clinical decision making. Discussion of therapeutic interventions used to restore function includes orthotic fabrication, manual therapy techniques, sensorimotor training, modalities, resistive exercises and functional training. 

Learning Outcomes: 

Upon completing this course, the learner will be able to:

• Compare and contrast primary bone healing and secondary bone healing as they relate to timelines for advancing therapy protocols. 
• Recognize one clinical sign of fracture healing.
• Identify causes of fracture nonunion. 
• Describe the effects of early controlled motion on fracture healing. 
• List conditions that can be seen on radiographs and other imaging methods.
• Identify complications to watch out for in a patient who has had a closed reduction with percutaneous pinning.  
• Explain how an external fixator influences fracture healing. 
• Compare and contrast the benefits and risks of open reduction internal fracture fixation vs closed reduction external support to the therapy program.
• Explain how dorsal hand and wrist edema can lead to delays in regaining function and permanent functional deficits.  
• Identify edema management techniques.
• Explain how the use of a safe position orthosis can influence the amount of post-fracture therapy needed and a patient’s ultimate function.  
• Identify complications that can occur during fracture rehabilitation and explain how these complications can significantly affect functional outcome. 
• Identify special considerations for pediatric fractures.
• Identify signs that scars are adhered to underlying tendons.
• Explain how graded motor imagery can be used to improve patients’ function.
• Explain how mirror box therapy can improve function.
• Explain the therapeutic effect of low load prolonged stress on contractures.
• Explain how early controlled motion can positively affect functional outcome.
• Explain how the blood supply of the scaphoid contributes to fracture nonunion.
• Recognize the progression from a scaphoid nonunion to an advanced scapholunate collapse. 
• Recognize problems in the design of an orthosis that will lead to contractures and skin problems.
• Explain why patients feel ulnar wrist pain with distal radius shortening after a fracture. 
• Explain why patients who have ulnocarpal impaction may complain of a greater amount of pain when gripping with the forearm pronated. 
• Explain why an EPL tendon might rupture over a distal radius fracture.
• Explain why restoration of normal wrist motion might not be the most appropriate goal for a 90-year-old following closed reduction and healing of a distal radius fracture. 
• Identify injuries that are commonly associated with intra-articular distal radius fractures.
• Explain why one might choose to start wrist AROM in the dart thrower’s plane of motion.
• Describe a grip activity modification for healing TFCC repairs.
• Recognize which types of strengthening exercises are best suited to different applications.
• Identify proper positioning of fractured or fractured and dislocated joints within an orthosis to protect all healing structures.
• Identify sensorimotor impairment and recognize treatment interventions to alleviate it.
• Describe 3 techniques for addressing scar adherence that limits tendon excursion.
• Identify 4 techniques for addressing IP extensor lags.
• Describe how vascularity effects mallet orthosis failure rates and identify 3 ways to mitigate risk of skin breakdown.
• Identify 3 proprioceptive training exercises for the thumb.