Scar, our body's "glue," is formed through a highly organized sequence of physiologic events. The ability of one type of collagenous tissue to weld various tissues, adapt to their structural integrity, impart tensile strength, and permit return of function is reviewed. A knowledge of wound healing enables the clinician to design and implement treatment strategies based on scar biology. The purposes of this overview are 1) to address the three phases of repair (inflammatory, fibroplastic, and remodeling), 2) to discuss the cellular processes occurring in each phase, 3) to review appropriate intervention methods based on research findings, and 4) to describe complications that interfere with normal healing.
Patients with common hand fractures are likely to present in a wide variety of outpatient orthopedic practices. Successful rehabilitation of hand fractures addresses the need to (1) maintain fracture stability for bone healing, (2) introduce soft tissue mobilization for soft tissue integrity, and (3) remodel any restrictive scar from injury or surgery. It is important to recognize the intimate relationship of these 3 tissues (bone, soft tissue, and scar) when treating hand fractures. Fracture terminology precisely defines fracture type, location, and management strategy for hand fractures. These terms are reviewed, with emphasis on their operational definitions, as they relate to the course of therapy. The progression of motion protocols is dependent on the type of fracture healing, either primary or secondary, which in turn is determined by the method of fracture fixation. Current closed-and open-fixation methods for metacarpal and phalangeal fractures are addressed for each fracture location. The potential soft tissue problems that are often associated with each type of fracture are explained, with preventative methods of splinting and treatment. A comprehensive literature review is provided to compare evidence for practice in managing the variety of fracture patterns associated with metacarpal and phalangeal fractures, following closedand open-fixation techniques. Emphasis is placed on initial hand positioning to protect the fracture reduction, exercise to maintain or regain joint range of motion, and specific tendon-gliding exercises to prevent restrictive adhesions, all of which are necessary to assure return of function post fracture.
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