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Elbow fractures Supracondylar humerus fracture
Lateral condyle fracture
Radial neck fracture
Medial condyle fracture
Forearm fractures Distal forearm fracture
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Types % Mechanism Age Remarks
Supracondylar 50-70% of elbow fractures
Fall with outstretched hand
4-7
Lateral condylar
10-20% of elbow fractures
ditto 4-10
Medial condylar
10% of elbow fractures
Fall with outstretched hand with excessive valgus stress
7-15 50-60% with concurrent elbow dislocation
Radial neck 6% of elbow fractures
Fall with outstretched hand with elbow in extension & valgus
Maybe associated with elbow dislocation
5
E. S. Hart, A. Turner, M. Albright et al. (2011) Common Pediatric Elbow Fractures. Orthopaedic Nursing. 30 (1) p.11-17.
Distal forearm fracture 75-84% of forearm fractures
Fall with outstretched hand
6
S. Carson, D. P. Woolridge, J. Colletti et al. (2006) Pediatric Upper Extremity Injuries. Pediatric Clinics of North America. 53, p. 41-67
Physiotherapy during immobilization period
Physiotherapy post-immobilization
Special physiotherapy for non-union/delayed union
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Physical examination
Reduce swelling/pain
Enhance mobility, including restoration of range of motion
strength & endurance
joint stability
co-ordination according to developmental milestones
Advice & home care
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Observation Swelling Muscle wasting
Palpation Increase temperature Tenderness
Movement Decrease range of motion Decrease muscle strength & endurance Decrease joint stability Impair co-ordination
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Active/assisted active mobilization exercise
Passive mobilization exercise
Accessory mobilization of individual joints
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Manual Neuromuscular facilitation
& inhibition techniques
Hold relax
Contract relax
Self-stretching
Incorporate with craniosacral therapy
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Muscle Re-education Biofeedback Electrical stimulation Kinesio Taping
Mechanical resistance exercise Manual resistance exercise Proprioceptive neuromuscular facilitation (PNF)
Functionally based diagonal patterns of movement Neuromuscular facilitation techniques to evoke motor
responses & improve neuromuscular control & function
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C. Kisner & L. A. Colby. (2007) Therapeutic Exercise: Foundations and Techniques. 5th edition. F.A. Davis Company. Philadelphia.
Kinesio Taping Facilitate muscle contraction
Other usage:
Inhibit muscle action
Facilitate superficial lymphatic drainage
25
Eye hand co-ordination
Co-ordination skill in simple sports activities Resume sports habit
e.g. badminton, table tennis
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Unwilling to remove the sling/to move Afraid of pain Misunderstanding Afraid of being hurt by others Overprotected parents
Too busy to move Focus only on academic activities Not understanding the importance of home programme
Moving too much Forget about the fracture while playing vigorously Eager to resume to sports/competition
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Magnetopulse
Low Intensity Pulsed Ultrasound (LIPUS)
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Y. Watanabe, T. Matsushita, M. Bhandari et al. (2010) Ultrasound for Fracture Healing: Current Evidence. Journal of Orthopaedic Trauma. 24,3 Supplement p. 56-61.
Safety
Fun
Alternatives
Relationship with children & parents
Understanding
Encouragement
Environmental factor
Well Done!
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1. E. S. Hart, A. Turner, M. Albright et al. (2011) Common Pediatric Elbow Fractures. Orthopaedic Nursing. 30 (1) p.11-17.
2. S. Carson, D. P. Woolridge, J. Colletti et al. (2006) Pediatric Upper Extremity Injuries. Pediatric Clinics of North America. 53, p. 41-67
3. C. Kisner & L. A. Colby. (2007) Therapeutic Exercise: Foundations and Techniques. 5th edition. F.A. Davis Company. Philadelphia.
4. M. R. Folio, R. R. Fewell (2000) Peabody Developmental Motor Scales. 2nd edition. Pro-ed, Inc. Texas.
5. Electrophysical Agents. Contraindications & Precautions: An Evidence-based Approach to Clinical Decision Making in Physical Therapy. Physiotherapy Canada 2010 Special Issue Vol 62 No.5
6. S. Kitchen & S. Bazin (2002) Electrotherapy: Evidence-Based Practice. 11th edition. Churchill Livingstone.
7. Kinesio Taping® Association International. (2011) Course material of KT1: Fundamental Concepts of the Kinesio Taping® Method & KT2: Advanced Concepts and Corrective Techniques of the Kinesio Taping® Method.
8. M. Y. Boyette & J. A. Herrera-Soto (2012) Treatment of delayed or non-united fractures & Osteotomies with Pulsed Electromagnetic Field in Children & Adolescents. 35 (7) p. e1051-e1055.
9. Y. Watanabe, T. Matsushita, M. Bhandari et al. (2010) Ultrasound for Fracture Healing: Current Evidence. Journal of Orthopaedic Trauma. 24 (3) Supplement p.56-61.
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