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THE HEALING PROCESS

Phase 1: Inflammation

 

  • Key Signs: Pain, redness, swelling, heat, and loss of function

  • What's Actually Happening: Injury results in trauma to the periosteum and surrounding soft tissue. A hemotoma accumulates in the medullary canal and the exposed ends of vascular structures become clotted with blood and deteriorating osteocytes. This occlusion disrupts the blood supply. Then the typical inflammation process takes over: altered cellular metabolism and chemical mediators. There is a period of rapid vasoconstriction followed by rapid vasodilation as the body tries to protect itself.

  • What We Do: Top priority is immobilizing the hand in the position it was found. Refer for imaging to confirm diagnosis. Athlete is held out of participation.

  • Time: 4 days

Phase 2: Fibroblastic Repair

  • Key Signs: Signs of inflammation subside, swelling completely absent, less point tenderness, decreased pain with active and passive motions.    

  • What's Actually Happening: The hematoma from phase one begins to organize itself into a fibrous junction between the fractured ends. The soft fibrous callus eventually become woven bone as both internal and external calluses produce an influx in osteoblast activity to bridge the gap. 

  • What We Do: Make sure the athlete is maintaining cardiovascular endurance and core strength. Athlete transitions from a hard cast to a protective splint.

  • Time: Begins in weeks 3 or 4 and lasting for 3 or 4 months. 

Phase 3: Maturation and Remodeling

  • Key Signs: Callus reabsorbed and trabecular bone is laid down along lines of stress.

  • What's Actually Happening: Realignment of collagen fibers and continued breakdown and synthesis of collagen .Wolff's Law states that both bone and soft tissue will respond to the physical demands planed upon them causing them to remodel or realign along lines of tensile force.

  • What We Do: Increase stress with strengthening exercises to promote correct alignment. Though research is limited and uncertain, a bone growth stimulator may be benefical (Mollon, 2008)

  • Time: May take years. Remodeling is considered complete when bone has been restored to its former shape or a shape that can withstand the imposed stresses required.

The healing process of soft tissue and the healing process of fractures are similar but have slight subtle differences. With bone healing, however, there can be complications. In 2002, Fusetti et al. reviewed 105 non-thumb metacarpal fractures in, and found a 32% complication rate. Non-union and malunion fractures accounted for 15%, 10% complained of persistant stiffness, 8% failed to regain full movement, and 1% had deep infection (Kollitz, 2013). These conditions can result due to lack of blood supply to the fracture area, poor immobiliation of the fracture site, and infection, even with closed fractures. 

Phase of Bone Healing Provided by Prentice, 2003

10

OBJECTIVES

FOR

THERAPEUTIC REHABILITATION

  1. Structural integrity
  2. Pain-free joints and muscles
  3. Flexibility
  4. Muscular strength
  5. Muscular endurance
  6. Muscular speed
  7. Muscular power (strength and speed)
  8. Integrated & coordinated movements (skill patterns)
  9. Agility (speed and skill)
  10. Cardiovascular endurance
 

Created by Shannon Flynn & Jordan Devenney

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