例えば三輪 熱可塑性スプリント に載ってるmallet finger splint は作りやすいけど抜けやすい

    MALLET-SPLINT-WEB2_MED


    ならば、↑の既製品を如何につくるか、成書よりもこの動画が↓ 一番参考になる



    これならスプリントの余りの材料で指を筒状にしてかぶせて、穴を開けるだけ

    自分の指で先に作った方がより時間の節約ができるのであらかじめ作っておくことを勧める
    それから背側にクッションをあてるといい。 リングタイプや↑のタイプ、いずれにしても「DIP関節があたって痛い」という苦情があるので
    クッションはスプリント材の、SAKATA でいえばAA9460LAなど

    スプリントの付け方は以下を参照 要はテーブルにタオルでも敷いてDIP屈曲しないようにスプリントを挿入する 動画みたいに熱で溶かさないのであれば、指先にプッシュ式の石鹸を塗ってからのほうが指先まで挿入できる。

    できれば(痛みが落ち着いていれば)14日以内にリハビリを始める。その方が予後良好

    0日-7日 Active elbow, wrist, and hand exercises should be initiated immediately after injury.
    Shoulder pendulum exercises should be initiated immediately, and attempts at assisted shoulder flexion, abduction, and rotation should begin at 1-week post injury
    Initially, shoulder exercises were performed in the supine position and included forward elevation, external rotation, and internal rotation to the chest.

    maxresdefault


    3週― Isometric deltoid and cuff exercises
    4週― Once clinical fracture union was con- firmed, the sling was discontinued.(6週までに) 骨癒合確認後に、Active range of motion and deltoid and rotator cuff isometric strengthening was added.
    Active exercises were initiated in the supine position and progressed to the seated position. As range of motion improved, active resistance deltoid and rotator cuff exercises were begun.
    6週― progressive strengthening and stretching
    12週―an aggressive stretching and strengthening program was continued until final outcome was achieved


    ↓以下をまとめた

    . Absolute sling immobilization should only be performed over the first 7–10 days post injury
    Distal extremity exercises should be started immediately after the injury, and shoulder range of motion should be initiated within 10 days of the injury if pain allows

    Active elbow, wrist, and hand exercises should be initiated immediately after injury. Shoulder pendulum exercises should be initiated immediately, and attempts at assisted shoulder flexion, abduction, and rotation should begin at 1-week post injury

    Isometric deltoid and cuff exercises should be initiated at 3 weeks, and progressive strengthening and stretching can usually be initiated between 6 and 12 weeks

    . Initially, shoulder exercises were performed in the supine position and included forward elevation, external rotation, and internal rotation to the chest. The sling was continued for 4–6 weeks, and exercises were performed four times daily at home.

    Once clinical fracture union was con- firmed, the sling was discontinued. Active range of motion and deltoid and rotator cuff isometric strengthening was added. Active exercises were initiated in the supine position and progressed to the seated position. As range of motion improved, active resistance deltoid and rotator cuff exercises were begun. Three months after the injury, an aggressive stretching and strengthening program was continued until final outcome was achieved

    Nonoperative Treatment of Proximal Humerus Fractures
    file:///C:/Users/Ishioka1/Downloads/9783319089508-c1%20(3).pdf

    The patients deemed their daily life functions to be normal 8 weeks after the injury.

    Physiotherapy after fracture of the proximal end of the humerus. Comparison between two methods.
    https://www.ncbi.nlm.nih.gov/pubmed/6710092

    The review of the literature on proximal humerus rehabilitation suggests that treatment must begin immediately if the harmful effects of immobilization are to be avoided

    In the United Kingdom most patients are immobilized routinely for 3 weeks or longer and are referred for physical therapy.

    Proximal humerus fracture rehabilitation.
    https://www.ncbi.nlm.nih.gov/pubmed/16394751


    One hundred and four patients who had a minimally displaced fracture of the proximal part of the humerus (a so-called one-part fracture) were managed with a standardized therapy regimen and followed for more than one year. The clinical outcome was assessed on the basis of pain, function, and the range of motion of the shoulder. The duration of follow-up averaged forty-one months (range, twelve to 117 months). All fractures united without additional displacement. Eighty patients (77 per cent) had a good or excellent result, fourteen (13 per cent) had a fair result, and ten (10 per cent) had a poor result. Ninety four patients (90 per cent) had either no or mild pain in the shoulder, eight (8 per cent) had moderate pain, and two (2 per cent) had severe pain. Functional recovery averaged 94 per cent; forty-eight patients (46 per cent) had 100 per cent functional recovery. At the time of the most recent follow-up, forward elevation of the injured shoulder averaged 89 per cent; external rotation, 87 per cent; and internal rotation, 88 per cent that of the uninjured shoulder. The percentage of good and excellent results was significantly greater (p < 0.01) and external rotation was significantly better (p < 0.01) at the time of the latest follow-up for the patients who had started supervised physical therapy less than fourteen days after the injury than for the patients who had started such therapy at fourteen days or later.

    Functional outcome after minimally displaced fractures of the proximal part of the humerus.
    https://www.ncbi.nlm.nih.gov/pubmed/9052540


    受傷1週 バストバンド除去   患肢肩関節ができるだけzero positionに近づくように振り子運動をおこなう.自分で3~5分間の下垂位振り子運動を1日30分
    受傷4週 レントゲンで仮骨が見られることを確認し,臥位での他動可動域訓練,自動介助訓練を開姶
    受傷6週 痛み,骨癒合が良好であれば自動可動域訓練と肩関節の筋力トレーニング開始

    (上腕骨近位端骨折に対する保存療法の検討 整形外科と災害外科56 :(3)499-502,2007.)
    *振り子について、肘関節が屈曲位にある場合,骨折部に回旋力が加わる可能性あり

    セッティング 多施設(507施設)。28ヵ国。

    期間 登録期間は2000年12月-2002年4月。追跡期間は18ヵ月。追跡完了は2003年10月。

    対象患者 7599例。40歳以上で過去3ヵ月以内に虚血性脳卒中あるいはTIA発症歴があり,過去3年以内に次のリスク因子を1つ以上有する患者:虚血性脳卒中,MI,狭心症,糖尿病,症候性末梢血管疾患。虚血性脳卒中はTOAST(Trial of Org 10172 in Acute Stroke)分類によるものとした。
    【除外基準】重度の合併症,出血リスクが高い,大手術あるいは血管手術の予定など。

    方法 脳卒中患者のADL自立達成度をmodified Rankin Scale (mRS):下表 を用いて分類 、ADL自立達成の有無、達成時期を18か月間追跡調査 
    (ADL非自立をmRS 3以上 ADL自立をmRS2以下 と定義)
    各Scale症例のADL自立達成時期をコックス比例ハザード比モデルで検証した。

    追跡完了率 追跡完了率は96%

    結果
    mrs


    mRS 3以上の脳卒中1662例; 内訳
    moderate mRS 3 in 931
    severe (mRS 4) in 691
    very severe (mRS 5) in 40 について、

    18ヶ月後、877名の患者(52.8%)がADL自立達成 内訳
    moderate mRS 3 in 589 (63%)  平均3か月で達成
    severe (mRS 4) in 281 (40.6%) 
    very severe (mRS 5) in 7 (17%)  


    末梢動脈疾患(閉塞性動脈硬化症)、DM、脳卒中既往が無ければ有意に回復が見込める


    Rate, degree, and predictors of recovery from disability following ischemic stroke

    Objective: To determine the rate, degree, and predictors of recovery from disabling ischemic stroke.

    Methods: Patients with ischemic stroke enrolled in the Management of Atherothrombosis With Clopidogrel in High-Risk Patients (MATCH) study underwent long-term prospective assessment of their modified Rankin Scale (mRS) score. Disability (functionally dependent state) was defined as mRS ≥ 3, and recovery (functionally independent state) was defined as mRS < 3. The timing and the independent predictors of recovery were determined using a Cox proportional hazards multiple regression analysis.

    Results: Of 7,599 patients enrolled with ischemic stroke or TIA, 1,662 (21.8%) were disabled (mRS ≥ 3) at baseline (median of 14 [0 to 96] days after stroke onset). Disability was moderate (mRS 3) in 931 (56%) patients, severe (mRS 4) in 691 (42%), and very severe (mRS 5) in 40 (2%). By 18 months, 877 (52.8%, 95% CI 50% to 55%) patients had recovered, 589 (63%, 60% to 66%) with moderate disability, 281 (41%, 37% to 44%) with severe disability, and 7 (17%, 7 to 33%) with very severe disability. Median time to recovery was 3 months for patients with moderate disability and 18 months for severe disability; 82.5% of severely disabled patients remained so at 18 months. Predictors of recovery were moderate disability (mRS 3) at baseline compared with severe (mRS 4: hazard ratio [HR] 2.13, 1.86 to 2.44) or very severe disabling stroke (HR 5.88, 2.86 to 12.5); younger women (aged <65 years, compared with ≥75 years; HR 1.85, 1.47 to 2.33); decreasing time (days) between the qualifying event and the baseline assessment (HR 1.01, 1.01 to 1.02); and the absence of previous ischemic stroke (HR 1.61, 1.35 to 1.92), concurrent peripheral artery disease (HR 1.61, 1.23 to 2.13), or diabetes (HR 1.30, 1.10 to 1.54).

    Conclusions: Half of patients with disabling ischemic stroke recovered within 18 months, and recovery was greatest within 6 months. Significant predictors of recovery included the severity of the index stroke and no history of ischemic stroke, peripheral artery disease, or diabetes.

    55277d8a-1660-41f1-a2e6-69736dcb7170


    1 The fractures of the greater tuberosity of the proximal humerus

    treated nonoperatively

    0-10days immobilization using a Gilchrist bandage until pain relief was achieved, followed by oscillating movements of the arm.
    3–4 weeks active ROM
    6-8 weeks bear weight on their arms

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3247891/

    Nonoperative treatment for a nondisplaced greater tuberosity fracture has been reported to include

    1 week passive range of motion (PROM)
    6 weeks active range of motion (AROM) followed by gradually progressed strengthening once full PROM is reached.

    http://www.jospt.org/doi/pdf/10.2519/jospt.2005.35.8.521


    minimally displaced (<3 mm) fractures of the greater tuberosity
    0-3weeks patients were immobilized in a sling
    3 to 6 weeks pendular and active assisted exercises
    6weeks active exercises

    https://www.ncbi.nlm.nih.gov/pubmed/23639834

    60歳以上・脱臼を合併した症例は特に受傷後2週以内に骨片の転位が進行する可能性があるため早期手
    術を考慮する必要がある.
    「上腕骨大結節骨折における骨片転位の予測因子」


    Neerは10mm未満の転位を,仲川は大結節の前方部であれば5mm,大結節後方部のみの骨片は10mm以内を保存療法の適応と述べた

    治療は3週間体幹固定がおこなわれ,3週経過後より可動域訓練,6週から腱板強化訓練おこなわれた.
    「当科における上腕骨大結節骨折の治療指針」


    2 Shoulder dislocation

    immobilization in 10° of external rotation for three weeks reduces the relative risk of recurrence of a
    first-time traumatic anterior shoulder dislocation when compared with the risk associated with conventional immobilization in internal rotation.
    Immobilization in external rotation after shoulder dislocation reduces the risk of recurrence. A randomized controlled trial. J Bone Joint Surg Am. 2007; 89:2124-2131
    http://medicine.tums.ac.ir:803/Users/ramin_espandar/Journal%20Club%20Articles/=Immobilization%20in%20External%20Rotation%20After%20Shoulder%20Dislocation%20Reduces.pdf


    The recognition and treatment of first-time shoulder dislocation in active individuals. JOSPT. 2009;39(2):118-123

    Decisions are made based on the age, activity level of the patient. Generally those that are involved in contact sports and ages 15 to 25 years acute repair may be a viable option based on the high risk of reacurrance, apprehension, impact on sports participation and quality of life, they favour arthroscopic instability repair for athletes in this age group.
    Patients who are age 25-40 have a much lower recurrence rate of dislocation in general and conservative treatment is generally the best RX.

    Older patients over 40, who sustain a Anterior dislocation have lower recurrence rates again but can residual disability from associated soft tissue injuries such as a rotator cuff tear, nerve injury or vascular injury.

    Traditional no-operative treatment has included a period of immobilisation with the arm in internal rotation for 6 weeks, this has not reduced the recurrence rate. Degenerative joint disease was found in both surgical and non-surgical cases.
    A short term clinical study revealed decreased recurrence rates in patients that were immobilised in ER. After 3 weeks of immobilisation they had a recurrence rate of 26% while those who were in IR had a 42% reccurance rate and 46% in patients that were younger than 30 years old.
    Athletes who sustain a first time dislocation at the end of the season or spring practice, one option is early mobilisation, rehabilitation and return to full activity. Another option is to immobilise for 3-4weeks, proceed with rehab, and return the athlete to sport after 6-8 weeks.
    In the young, contact athlete, modern operative stabilisation (open and arthoscopic) which reduces the recurance rate from the 80%-90% range-3-15% range. This is preferred with first time dislocation as the reccurane rate is decreased and it improves a better quality of life.
    The first 2 weeks after the injury occurs is the best time to operate, taking advantage of the good condition of the capsulolabral tissue. Focus of surgery is to repair the capsulolabral avulsion with suture anchors.


    Shoulder Dislocation Original Editor - Haley Stevenson and Sherin Mathew as part of the Temple University EBP Project

    Phase 1 (up to 6 weeks)[1]: Goal is to maintain anterior-inferior stability

    Immobilization
    It has traditionally been thought to be immobilized with internal rotation, but according to Miller, immobilization has been beneficial in external rotation because there is more contact force between the glenoid labrum and the glenoid.[3] Research by Itoi[4] suggests immoboilization at 10 degrees of external rotation has a lower recurrence rate than internal immoboilization at 10 degrees of external rotation has a lower recurrence rate than internal rotation.[4] There is currently no consensus on the duration of immobilization in a sling.[5] But, typical time periods in a sling range for 3-6 weeks if under the age of 40 and 1-2 weeks if older than the age of 40.[4] During the immobilization period, the focus is on AROM of the elbow, wrist and hand and reduction of pain. Isometrics can be incorporated for the rotator cuff and biceps musculature.

    Codman Exercises
    AAROM for external rotation (0-30º) and forward elevation (0-90º)







    Phase 2 (6-12 weeks)[1]: Goal is to restore adequate motion, specifically in external rotation

    AAROM to achieve full range of motion
    When stretching is permitted, passively stretch the posterior joint capsule through the use of joint mobilizations or self-stretching.
    No strengthening or repetitive exercises should start until achievement of full range of motion

    Phase 3 (12-24 weeks)[1]: Successful return to sports or physical activities of daily living

    Begin strengthening exercise
    Strengthening exercises should be impairment-based. Typically begin strengthening exercise in a pain-free motion with exercises for stability. A possible progression could begin by focusing on the rotator cuff musculature and scapular stabilizers, which include trapezius, serratus, levator scapulae, and rhomboids. Then, progress to the larger musculature such as the deltoids, latissimus dorsi, and pectorals.
    Start focusing on functional exercises
    Include proprioceptive training
    Tailor to promote patient's activities and participation in society

    http://www.physio-pedia.com/Shoulder_Dislocation

    Epidemiology

    約12%に橈骨神経麻痺が合併する  Anglen JO, Archdeacon MT, Cannada LK, et al.
    Avoiding complications in the treatment of humeral fractures. Instr Course Lect 2009;58:3-11.

    肘関節より末梢で障害された場合
    ◦手関節の伸展は可能だが,伸展時に手関節は橈屈する.
    ◦母指と他指の MP(metacarpophalangeal:中手指節)関節の伸展不良.

    肘関節より中枢で障害された場合
    ◦下垂手(手掌を地面に向けると手関節と MP 関節が下垂し背屈できない〔drop hand〕
    ◦「肘関節より末梢で障害された場合」と同じ症状も出る.

    整形外科看護 2013 vol.18 no.4 (361)

    上腕骨骨幹部骨折に対する髄内釘治療について,過去の報告では偽関節発症率は0~19%であり,合併症や追加手術が必要となることがプレート固定と比較して多いと報告されている
    上腕骨骨幹部骨折髄内釘固定法の結果、40歳以上の症例では肩関節機能障害が高頻度に生じた. 骨折第31巻No.32009

    1) Lin J, Shen PW, Hou SM. Complications of locked nailing in humeral shaft fractures. J Trauma 2003 ; 54 : 943-949,
    2) McCormack RG, Brien D, Buckley RE, et al.Fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail. A prospective, randomised trial. J Bone Joint Surg Br 2000 ; 82 : 336-339.
    3) Ajmal M, O’Sullivan M, McCabe J, et al.Antegrade locked intramedullary nailing in humeral shaft fractures. lnjury 2001 ; 32 : 692-694.
    4) Habernek H, Orthner E. A locking nail for fractures of the humerus. J Bone Joint Surg Br 1991 ; 73 : 651-653.
    5) Bhandari M, Devereaux PJ, McKee MD, et aL Compression plating versus intramedullary nailing of humeral shaft fractures一一a meta-analysis. Acta Orthop 2006 ; 77 : 279-284,


    achot_2011_3_185_a



    Humeral shaft fractures account for 1 to 3% of all fractures in adults [1, 2] and for 20% of all humeral fractures
    https://trialsjournal.biomedcentral.com/articles/10.1186/1745-6215-14-246

    Bone union period
    AO分類のA, B, Cの順に骨癒合期間が長くなる傾向があり
    type Aで平均53日,type Bで平均102日, type Cで平均120日

    「上腕骨骨幹部骨折に対するInterlocking nailの治療経験」


    Rehabilitation protocol
    Postoperative Protocol For Intramedullary Nailing of Humerus Fractureshttps://www.advancedorthopedicspecialists.com/sites/advancedorthopedicspecialistsV2.com/files/(P)%20Humerus%20Fracture%20IMN.pdf

    Postoperative Days 0-14
    Goals:
    1. Protect fracture repair
    2. Minimize swelling and pain.
    3. Optimize independence while accomplishing the above.

    Review postoperative precautions with patient and care-partner.
    o No shoulder AROM.
    o No lifting of objects
    o When reclining or lying supine, the patient is encouraged to keep a pillow or blanket behind their elbow, preventing extension through the shoulder, to reduce stress on the anterior repair site. As a rule of thumb, the patient should always be able to see their elbow.
    o No excessive shoulder motion beyond side pocket, especially into internal rotation(IR)
    o No excessive stretching or sudden movements (particularly external rotation (ER))
    o No supporting of body weight by hand or elbow on involved side
    o May shower at 4 days postop, letting water run over the skin and patting dry with a clean towel. No standing in a pool or bathtub for 3 weeks. No swimming for at least 10 weeks.
    o No driving for 6 weeks

    Home education therapy:
    · Instruct in scapular elevation, depression, retraction, and protraction (clock exercises)
    · Preview safety and ADLs for life in a sling. Emphasize donning and doffing of shirts.
    · Patient may remove sling for short periods of time and allow elbow to extend fully.
    · Instruct patient and family in 6-pack exercises for upper extremity:

    1. Clockwise shoulder pendulum
    2. Counterclockwise shoulder pendulums
    3. Tight fist-- patient makes a tight fist then fully extends fingers
    4. Thumb to shoulder-- the patient flexes the elbow to touch the anterior shoulder with the tip of their thumb and then extends the elbow fully.
    5. Front-assisted forward elevation: using either a cane or dowel (broomstick), the patient grasps the device with hands 6 inches apart. They then use their uninjured extremity to slowly lift the injured arm. The deltoid of the injured arm should not contract actively. The arm is lifted to the point of mild discomfort, then gently lowered back to the resting position.
    6. Side-assisted lift: the same dowel is used but hands are placed shoulder-width apart.The uninjured arm pushes the dowel to the injured side, abducting the injured structure with no active muscle contraction of its own.


    2 weeks--

    ❏ 3-views of proximal humerus for comparison with intraoperative x-rays.
    ❏ Assess pain control/ refill or adjust pain medications as needed.
    ❏ Formal therapy requirement:
    ❏ if forward elevation>90⁰: continue with HEP alone.
    ❏ If forward elevation<90⁰ or if elbow, wrist, or hand have any noticeable limitation: start formal therapy.
    ❏ Review postoperative precautions and activity limitations.
    ❏ Work Limitations: No use of operative arm for other than typing or writing. No lifting, pushing, or pulling. Full-time sling use at job site. No driving/ operation of medium+ machinery.
    ❏ Expected return to work:
    ❏ Cognitive work: 1-2 weeks
    ❏ Light manual (retail/ light personal service): 8 weeks
    ❏ Manual labor: 12-14 weeks
    ❏ Overhead lifting intensive manual work: 4-6 months
    ❏ Follow-up visit in 4 weeks.

    Therapy Rx Weeks 2-6:
    ● 1-2x/week x 4 weeks
    ● PROM of shoulder in plane of scapula. No IR/ ER> 30degrees.
    ● AROM/ PROM of elbow, wrist, and hand.
    ● Scapular isometrics in protraction, retraction, elevation, and depression.
    ● Modalities prn for muscle relaxation
    ● HEP


    2nd postoperative visit at 6 weeks--
    ❏ 3-views of proximal humerus for comparison with intraoperative x-rays.
    ❏ Assess pain control/ refill or adjust pain medications as needed.
    ❏ Review postoperative precautions and activity limitations.
    ❏ Therapy Rx:
    ❏ If patient shows bridging bone at three+/four cortices on AP and axillary views,
    advance to formal therapy.
    ❏ Paucity of callus (<3 cortices bridged) or focal tenderness persisting at shoulder
    results in continuing sling and AROM restrictions for another 2 weeks, then
    reassessing in office.
    ❏ Work Limitations: Limit 20# weight. No pushing or pulling. No overhead activity. May
    drive.
    ❏ Return to work:
    ❏ Cognitive work: 1-2 weeks
    ❏ Light manual (retail/ light personal service): 8 weeks
    ❏ Manual labor: 12-14 weeks
    ❏ Overhead lifting intensive manual work: 4-6 months


    Therapy Weeks 6-12:
    ● 1-2 x/ week for 6 weeks
    ● AROM/ AAROM/ gentle PROM of shoulder, elbow, wrist, and hand. Emphasize ER and pec minor stretching early to minimize scapular protraction with forward elevation.
    Scapular mechanics are critical to early progress with active range of motion.
    ● Okay to start light glides and mobilization maneuvers at 8 weeks postoperative.
    ● May start light strengthening for the rotator cuff at 10 weeks.
    ● General upper extremity strengthening at 12 weeks.


    上腕骨骨幹部骨折に対する髄内固定法について、後療法は

    術後3日目 振り子運動と他動運動を開始
    2週目 自動運動を開始 ,アームスリングを併用

    上腕骨骨幹部骨折における順行性髄内釘は逆行性髄内釘より肩関節の挙上・外旋運動に可動域制限を残す.
    この理由として順行性髄内釘の挿入時に棘下筋腱の線維を切離している可能性と腱板のfootprintに挿入口がかかっている可能性が示唆された.

    「上腕骨骨幹部骨折に対する順行性・逆行性髄内固定法における肩関節への影響」骨折 第31巻No.12009  


    後療法については,骨折型,骨折レベルにかかわらず,

    手術翌日 三角布固定のみとして,三角布内での振り子運動,肘関節の自動運動を開始
    術後3週目 肩関節屈曲90度以上の関節可動域の拡大へと訓練を進めた.

    「上腕骨骨幹部骨折に対して横止め式髄内釘固定を用い,早期に生活基本動作を獲得・有用であった症例」


    Operative vs Non-operative
    Standard treatment for most humeral shaft fractures is nonoperative functional bracing; however, certain clinical scenarios necessitate operative intervention. There have been few studies in the literature comparing nonoperative and operative fixation of humeral shaft fractures. Two-hundred thirteen adult patients with a humeral shaft fracture who satisfied inclusion criteria were treated at 2 level 1 trauma centers with either a functional brace (nonoperative treatment group) or compression plating (operative treatment group). Main outcome measures were evaluated retrospectively and included time to union, nonunion, malunion, infection, incidence of radial nerve palsy, and elbow range of motion (ROM). The occurrence of nonunion (20.6% vs 8.7%; P=.0128) and malunion (12.7% vs 1.3%; P=.0011) was statistically significant and more common in the nonoperative group. There was no significant difference in infection rate between nonoperative and operative treatment (3.2% vs 4.7%; P=1.0000). Radial nerve palsy presented after fracture treatment in 9.5% of patients in the nonoperative group and in 2.7% of patients managed operatively (P=.0678). No difference in time to union or ultimate ROM was found between the 2 groups. Closed treatment of humerus fractures had a significantly higher rate of nonunion and malunion while operative intervention demonstrated no significant differences in time to union, infection, or iatrogenic radial nerve palsy. Nonoperative management has historically been the treatment of choice for many humeral shaft fractures, however, in certain clinical scenarios these fractures may be well served by compression plating.
    http://www.healio.com/orthopedics/journals/ortho/2010-8-33-8/%7B5c428edd-6106-4957-a77b-746144fd943c%7D/outcome-of-nonoperative-vs-operative-treatment-of-humeral-shaft-fractures-a-retrospective-study-of-213-patients

    Non-operative protocol
    0-14days U-splint
    14days- functional brace
    For allowing the patients to move their shoulder and elbow freely to exercises and rehabilitation. This brace will be kept until fracture consolidation, determined on radiography by two previously-assigned assessors.
    21days- pendulum exercises with the elbow in extension were begun.
    When roentgenographic and clinical evidence of good callus formation was demonstrated, the splint was removed for periods of time.
    https://smhs.gwu.edu/orthopaedic-surgery/sites/orthopaedic-surgery/files/Sarmiento%20Humerus.pdf

    7-8weeks functional brace was removed
    (median of 8.5 weeks and a mode of seven weeks)

    このページのトップヘ