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- Treatment Rehabilitation Fractures by Stanley Hoppenfeld
- Fractures: Types and Treatment
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- Pediatric Traumatology, Orthopaedics and Reconstructive Surgery
Treatment Rehabilitation Fractures by Stanley Hoppenfeld
The modern approach to the treatment of unstable fractures of the thoracolumbar and lumbar spine in children is surgical stabilization at the early stages after trauma by using metal structures that quickly restore vertical functionality to the patient and shorten the period of inpatient treatment.
However, the issues related to restorative treatment have not been sufficiently addressed. To develop an algorithm for restorative treatment of children at the inpatient stage after surgical treatment of unstable uncomplicated fractures of the thoracolumbar and lumbar spine.
Material and methods. Based on the results of treatment of 73 patients aged 9 to 17 years with unstable uncomplicated vertebral fractures, an algorithm of stage-by-stage rehabilitation by means of therapeutic gymnastics depending on the severity of the injury, method of surgical stabilization of the spine, physical condition of the child, and time passed after the operation was developed.
Results and discussion. The use of differentiated groups of respiratory gymnastics and isometric and dynamic exercises for muscle groups restored vertical functionality to patients in 1—3 days after surgery, restored spine and motor functions, and shortened the duration of inpatient treatment to a range of 10—14 days.
The developed algorithm for physical rehabilitation of children after surgical treatment of unstable injuries of the thoracic and lumbar spine by using metal structures at the inpatient stage contributed to the selection of the most rational and effective program of restorative treatment.
In recent years, there has been an increase in the number of children with spinal injuries of different locations. According to the statistical data of St.
The most common spinal traumas observed in pediatric patients are vertebral compression fractures. However, in the structure of the spinal column injuries, the number of unstable and complicated vertebral fractures of various locations has increased.
According to a trial by Russian researchers, the total prevalence of these types of injuries is 0. We have described in detail the various approaches and types of surgical interventions for pediatric patients with unstable vertebral fractures.
Surgical technologies used in the initial hours and days after the injury enable the elimination of instability of the spinal motion segment and restoration of the correct anatomy of the injured spine . Dorsal and ventral approaches during surgical treatment provide favorable anatomical and functional results, thus shortening the hospital stay to 10—14 days [3, 4].
However, it is noteworthy that modern surgical technologies for treating these patients require appropriate physical rehabilitation methods. At present, there practically are no methods involving a combined approach for rehabilitation treatment of pediatric patients with unstable spinal injuries. The majority of such patients are currently receiving treatment according to previously developed methods. Many authors have reported that commonly, particularly in the remote regions of Russia, rehabilitation treatment for uncomplicated vertebral fractures, particularly for compression fractures, is performed as per the principles proposed by E.
Dreving in . The program involves a long-term compliance with bed regime up to 2 months and performance of isotonic and isometric exercises . However, modern standards of treatment involve a more intense treatment process with a reduction in the hospital stay and transfer of the rehabilitation measures to outpatient settings [7, 8]. In contrast, the development of new surgical technologies, including transpedicular fixation of the vertebrae with metal structures and fusion using Pyramesh, for treating unstable spinal fractures in children enables an early elimination of spinal instability [3, 4].
Some previous trials have indicated the periodic performances of motor activity walking, sitting, and therapeutic exercises without a clear physiological justification in terms of rehabilitation treatment. The scientific publications devoted to rehabilitation treatment of pediatric patients with unstable vertebral fractures of the thoracic and lumbar spine following surgical intervention contain some recommendations without proper physiological justification in terms of physical rehabilitation involving expansion of the motor regime, particularly the vertical position, dosed walking, and sitting.
Further, there is no indication of continuity and phasing of the treatment. The study aimed to develop an algorithm for the rehabilitation treatment at a steady state stage of pediatric patients with unstable vertebral fractures of the thoracolumbar and lumbar spine following surgical intervention. In total, 73 pediatric patients 9—17 years with unstable uncomplicated spinal fractures were observed.
In Denis classification. On the basis of the age-related anatomical and physiological features of the spine, condition of the muscular corset, and functional parameters of the cardiovascular and respiratory systems, the observed patients were divided into 2 age groups: 9—12 years and 13—16 years.
The indicators measured during the study, which characterized the functional state of organs and systems, were compared with the age norms. All the patients were examined comprehensively. During the clinical examination at admission, which was performed with the patient in the prone position, attention was paid to skin integrity, presence of hematomas and pathological swelling, condition of the muscular-ligamentous apparatus, and the severity of the physiological spinal curvatures.
The functional parameters of the cardiovascular and respiratory systems, including pulse rate PR , were measured; arterial blood pressure BP and respiratory rate RR were monitored during the postoperative period in the intensive care unit and throughout the postoperative follow-up at the various stages of rehabilitation treatment.
The spine roentgenogram was developed using 2 projections: a computed tomography of the spine to accurately identify the injuries and magnetic resonance imaging to exclude damage to the central canal of the spinal cord and to the spinal cord. Depending on the clinical and radiological state of the structural injuries to the vertebrae and on the vertebral-motor segment instability, all patients underwent surgical treatments, such as posterior indirect reposition and stabilization with transpedicular fixation in case of burst fracture observed with spondylosyndesis and fusion with reconstruction of the anterior and middle columns at the damage level of Pyramesh with a pronounced degree of destruction and displacement of the vertebral bodies.
In the preoperative period, the pediatric patients required physical rehabilitation treatment when the postoperative surgical treatment was delayed owing to late hospital admission. The rehabilitation exercises included respiratory gymnastics and isometric and isotonic exercises. An analysis of the anamnestic data regarding the spinal injury timing was performed. Moreover, results of the initial examination and specialized examination were analyzed.
When a patient with unstable spine injuries was admitted, during the initial orthopedic neurological examination and at the stages of the in-depth specialized examination, the need for preoperative preparation using therapeutic gymnastics was determined.
The preoperative preparation tasks were determined as per the trauma severity and its extensiveness; indices of orthopedic, neurological, and somatic status; and forthcoming surgical intervention duration. These tasks included the following:. The general condition of the patients was indicated as moderate or severe.
In all pediatric patients, regardless of their age, deviations in the psycho-emotional state caused by pain due to the pain syndrome, negative emotions associated with the circumstances of the trauma, and fear of the forthcoming surgical intervention were observed. The psycho-emotional state was stabilized using sedatives that are a part of the preoperative premedication complex and by creating a favorable psychological climate. The tasks set by the means of therapeutic gymnastics were performed at the stationary stage on postoperative day 1 postoperative department ward in the supine position while observing strict bed rest.
BP in all the patients was within the normal limits for their ages. Isotonic exercises for the chest and abdomen muscles aimed to eliminate congestion and prevent possible complications.
The patients also performed dynamic exercises for the distal parts of the upper and lower extremities. Thus, on postoperative day 1, all tasks for preventing hypodynamia and creating a favorable psychological climate were performed. The general condition of all the patients on postoperative day 2 was observed to be satisfactory, allowing their transfer to the intensive care ward of the spinal pathology department for the next stage of physical rehabilitation.
This stage involved the preparation for verticalization and restoration of the spinal support capacity. The complex exercises performed on postoperative day 1 were expanded due to an increase in the exposure and number of repetitions of exercises already mastered post operation.
For early verticalization preparation, the possibility of which in the early period was provided by surgical stabilization of the damaged spine, the dynamic exercises for the joints of the upper and lower extremities were introduced.
Patients performed the bending movements of the knee and hip joints while lying and with their heels sliding on the surface of the bed to avoid any additional load on the lumbar spine. The bending of the hip joint was done with external rotation. The exercises lead to passive over-extension of the lumbar spine and additional compression of the anterior parts of the vertebrae. Thus, a set of selected dynamic exercises are justifiable from an anatomical and biomechanical point of view.
Verticalization is performed with the patients lying on their stomachs by flexing the arms at the elbow joints and resting against the bed with the help of their palms. The halt in the vertical position was strictly dosed with the unloading of the spine in the prone position.
When the patient was transferred to the general ward of the Traumatology and Orthopedic department on postoperative day 3 or 4, the motor activity gradually increased and partial bed rest was observed.
Assessment of the overall physical condition of the patient, severity of the consequences of trauma and surgical intervention, anatomical and functional state of the muscular corset, and age and psychological characteristics served as the basis for the compilation of individual complexes of therapeutic gymnastics at this stage of physical rehabilitation.
Monitoring the RR, PR, BP, and muscle tone at rest and in tension based on palpation control enabled the determination of the appropriate recommendations for compiling a set of therapeutic exercises from various initial positions, such as lying on the stomach, lying on the back, and standing. To restore the chest excursion and breathing pattern, it is necessary to perform static and dynamic breathing exercises.
Exercises for different muscle groups were performed in both isometric static and isotonic dynamic modes with a gradual increase in the muscle load owing to an increase in the exercise exposures and the number of repetitions. The patient was trained on the elements of domestic services, acceptable body bending with a straight back due to bending in the hip joints, wall-sitting, and turning with a small amplitude of the trunk.
At this stage of physical rehabilitation, walking was performed in a functional corset with stiffening ribs and elastic ties. These results enabled us to develop an algorithm using surgical hardware for the physical rehabilitation of patients with unstable vertebral injuries of the thoracolumbar and lumbar spine at a steady state stage following surgical intervention Fig.
Algorithm of the physical rehabilitation of pediatric patients following surgical intervention for unstable vertebral injuries of the thoracolumbar and lumbar spine using surgical hardware in the steady state stage. The proposed algorithm enabled us to resolve all the problems of rehabilitation treatment in children with trauma at the stationary stage and to restore the spinal support capacity and motor functions, enabling the shortening of the postoperative hospital stay to 10—14 days.
The patients were discharged with recommendations for wearing a functional corset and continuing the course of rehabilitation treatment during the outpatient stage. Modern treatment approaches for unstable vertebral injuries of the thoracic and lumbar spine in children enable surgical stabilization of the damaged spine with the use of the most advanced surgical hardware during the initial hours and days after trauma.
Physical rehabilitation of patients during the postoperative period is performed in the hospital in various stages, according to the developed algorithm. Gradual expansion of the postoperative regimen, respiratory gymnastics, and dosed load on the spine with a combination of isotonic and isometric exercises for the muscle groups allow an early 1—3 days preparation of the patient for verticalization after the surgery, restore the spinal support capacity and motor functions, and reduce the hospital stay to 10—14 days.
The algorithm developed for the physical rehabilitation of pediatric patients following surgical intervention for unstable vertebral injuries of the thoracic and lumbar spine using surgical hardware at the steady state stage aids the selection of the most rational and effective program of rehabilitation treatment.
This study was conducted within the state contract framework for performing research as per the Union State program on the topic, Development of new spinal systems with the use of prototyping technologies in the surgical treatment of children with severe congenital deformities and spinal injuries.
The authors declare no obvious or potential conflicts of interest related to the publication of this manuscript. Author for correspondence. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. User Username Password Remember me Forgot password? Notifications View Subscribe. Subscription Login to verify subscription.
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Request permissions. Keywords arthrogryposis cerebral palsy child children clubfoot congenital scoliosis contracture deformity correction diagnosis external fixation foot hexapods hip joint idiopathic scoliosis infantile cerebral palsy microsurgery rehabilitation scoliosis surgical treatment treatment upper limb.
Rehabilitation of children at the inpatient stage after surgical treatment of unstable fractures of the thoracolumbar and lumbar spine. Authors: Ovechkina A. Keywords children , instable spine fractures , rehabilitation , inpatient rehabilitation , treatment strategy.
Full Text Introduction In recent years, there has been an increase in the number of children with spinal injuries of different locations.
Materials and methods In total, 73 pediatric patients 9—17 years with unstable uncomplicated spinal fractures were observed.
Fractures: Types and Treatment
The modern approach to the treatment of unstable fractures of the thoracolumbar and lumbar spine in children is surgical stabilization at the early stages after trauma by using metal structures that quickly restore vertical functionality to the patient and shorten the period of inpatient treatment. However, the issues related to restorative treatment have not been sufficiently addressed. To develop an algorithm for restorative treatment of children at the inpatient stage after surgical treatment of unstable uncomplicated fractures of the thoracolumbar and lumbar spine. Material and methods. Based on the results of treatment of 73 patients aged 9 to 17 years with unstable uncomplicated vertebral fractures, an algorithm of stage-by-stage rehabilitation by means of therapeutic gymnastics depending on the severity of the injury, method of surgical stabilization of the spine, physical condition of the child, and time passed after the operation was developed. Results and discussion.
Murthy MD Written by leading orthopaedists and rehabilitation specialists, this volume presents sequential treatment and rehabilitation plans for fractures of the upper extremity, lower extremity, and spine. The book shows how to treat each fracture--from both an orthopaedic and a rehabilitation standpoint--at each stage of healing. Subsequent chapters focus on management of individual fractures. Specific treatment strategies and rehabilitation protocols are then presented. More than illustrations complement the text. Download Treatment and Rehabilitation of Fractures Murthy MD Editorial Review Users Review From reader reviews: Pauline Mueller: Do you certainly one of people who can't read satisfying if the sentence chained inside straightway, hold on guys this kind of aren't like that.
Treatment and Rehabilitation of Fractures - Free ebook download as PDF File .pdf), Text File .txt) or read book online for free. carte fracturi.
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Pediatric Traumatology, Orthopaedics and Reconstructive Surgery
List of ebooks and manuels about Hoppenfeld treatment and rehabilitation of fractures. Treatment and Rehabilitation of Fractures by by Stanley Hoppenfeld MD This Treatment and Rehabilitation of Fractures book is not really ordinary book, you have it then the world is in your hands. The benefit you get by reading th Fractures. The medial approach allows easy. However, there is a controversy as far as the results of this instrumentation are concerned. The Closed Treatment of Common Fractures , 4th edn. McRae, R.
A bone may get fractured completely or partially and it is caused commonly from trauma due to fall, motor vehicle accident or sports. Thinning of the bone due to osteoporosis in the elderly can cause the bone to break easily. Overuse injury is a common cause of stress fractures in athletes. Our body reacts to a fracture by protecting the injured area with a blood clot and callus or fibrous tissue. Bone cells begin forming on either side of the fracture line. These cells grow towards each other and thus close the fracture. The objective of early fracture management is to control bleeding, prevent ischemic injury bone death and to remove sources of infection such as foreign bodies and dead tissues.
Skip to search form Skip to main content You are currently offline. Some features of the site may not work correctly. Hoppenfeld and V. Hoppenfeld , V. Murthy Published Medicine.
The methods used to treat femur fractures can vary, and rehabilitation is always necessary after the initial treatment, to restore full movement and mobility to the ankle and help the patient return to all usual activities. After the thigh bone has healed from the initial treatment for the fracture, and patients can bear weight on the leg and joint, a physical therapy regimen is implemented to strengthen muscles and increase mobility. Without proper rehabilitation, complications such as chronic pain, inflammation and weakness, may cause difficulty walking and performing physical activities. If the femur fracture does not require surgery, it is often treated with a cast or removable brace, and patients are typically advised not to put any weight on the leg for about 8 weeks. A physical therapist will help the patient to walk safely using crutches or a walker, or other assistive device.
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Вот и все доказательства. - Агент Смит, - прервал помощника директор. - Почему вы считаете, будто Танкадо не знал, что на него совершено покушение.
У нас возник кризис, и я пытаюсь с ним справиться. - Он задумчиво посмотрел на. - Я являюсь заместителем оперативного директора агентства. - Усталая улыбка промелькнула на его лице.
И вдруг увидел знакомый силуэт в проходе между скамьями сбоку. Это. Он. Беккер был уверен, что представляет собой отличную мишень, даже несмотря на то что находился среди огромного множества прихожан: его пиджак цвета хаки ярко выделялся на черном фоне.
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Движимый страхом, он поволок Сьюзан к лестнице. Через несколько минут включат свет, все двери распахнутся, и в шифровалку ворвется полицейская команда особого назначения.
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Я сказала, что нашла его в парке. Я думала, что она мне заплатит, но ничего не вышло. Ну, мне было все равно. Я просто хотела от него избавиться.
Вот он - истинный Стратмор. Он задумал способствовать распространению алгоритма, который АНБ с легкостью взломает. - Полный и всеобщий доступ, - объяснял Стратмор. - Цифровая крепость сразу же станет всеобщим стандартом шифрования. - Сразу же? - усомнилась Сьюзан.
Я занесу им, а вы, когда увидите мистера Густафсона, скажете ему, где его паспорт.
Лицо его снизу подсвечивалось маленьким предметом, который он извлек из кармана. Сьюзан обмякла, испытав огромное облегчение, и почувствовала, что вновь нормально дышит: до этого она от ужаса задержала дыхание. Предмет в руке Стратмора излучал зеленоватый свет. - Черт возьми, - тихо выругался Стратмор, - мой новый пейджер, - и с отвращением посмотрел на коробочку, лежащую у него на ладони.
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Ведь на нем - единственный экземпляр ключа! - Теперь она понимала, что нет никакой Северной Дакоты, как нет и копии ключа. Даже если АНБ расскажет о ТРАНСТЕКСТЕ, Танкадо им уже ничем не поможет. Стратмор молчал. Положение оказалось куда серьезнее, чем предполагала Сьюзан. Самое шокирующее обстоятельство заключалось в том, что Танкадо дал ситуации зайти слишком .
Старшие должностные лица АНБ имели право разбираться со своими кризисными ситуациями, не уведомляя об этом исполнительную власть страны. АНБ было единственной разведывательной организацией США, освобожденной от обязанности отчитываться перед федеральным правительством.