ASSESSMENT FOR FRACTURE

PATIENT DATA

Name Age/sex Occupation Address

SUBJECTIVE EXAMINATION

Chief complaints

All should be patient words

for how many days patient suffering from the problem How the problem started sudden or gradual

History of chief complaints

Trauma Stress fracture Pathological fracture RTA Fall from height

History of trauma

Position of fall From what height Fall on what surface

Surgical history

Date of surgery Type of incision/ surgery Type of fixation- k-wire/ intra-medullary/ external nailing Relevant to the problem any previous history

Past history

Degenerative disease

Medical history

h/o diabetic, hypertensive, epileptic or cancer What are the drugs presently taking Smoking/ alcoholic (it can increase the healing time) Poor/ medium/ high income group

Drug history

Personal history

Socio-economic status

PAIN ASSESSMENT

Onset

Sudden/gradual

Duration Side Site Type

Aching Dull-aching

Character

Continuous/ intermittent
Traumatic/ degenerative

Nature

Aggravating factor Alleviating factor Severity

Numerical

pain rating scale / visual analog scale

Pain mapping 24 hour pattern

OBJECTIVE EXAMINATION

Vital signs

Blood pressure Pulse rate Respiratory rate Body temperature Body built

On observation

Ectomorphic/ mesomorphic/ endomorphic

Oedema Colour of the skin (any signs of circulatory complication) Any infection Presence of any open wound/ surgical incision Mobility level of the patient Deformity Muscle atrophy Presence of any external device Psychological status

On palpation
Pulse
Upper

limb- axillary and radial pulse Lower limb- femoral and dorsalis pedis
Edema Warmth Tenderness

On examination
Range
Muscle

of motion
passive/ end feel

Active/

power Muscle girth

END FEEL (NORMAL)

END FEEL Soft Firm STRUCTURE Soft tissue approximation Muscular stretch Capsular stretch EXAMPLE Knee flexion (contact between soft tissue of posterior thigh) Hip flexion with knee straight ( passive elastic tension of hamstring muscle) Extension of MCP joint of finger ( tension in the anterior capsule) Forearm supination (tension in the palmar radioulnar ligament of the inferior radioulnar joint: interosseous membrane, oblique cord Elbow extension ( contact between the olecranon process of the ulna and the olecranon fossa of the humerus)

Ligamentous stretch

Hard

Bone contacting bone

END FEEL (ABNORMAL)

End feel Soft Occurs sooner or later in the ROM than is usually, or in a joint that normally has a firm or hard end-feel. Feels boggy Occurs sooner or later in ROM than is usual, or in a joint that normally has a soft or hard end-feel Occurs sooner or later in the ROM than is usual or in a joint that normally has a soft or firm end-feel. A bony grafting or bony block is felt No real end-feel because pain prevents reaching end of ROM. No resistance is felt exept for patients protective muscular splinting or muscle spasm example Soft tissue edema synovitis Increased muscular tonus Capsular, muscular, ligamentous and fascia shortening Chondromalacia Osteoarthritis Loose bodies in joint Myosotis ossificans fracture Acute joint inflammation Bursitis Abcess Fracture Psychogenic disorder

Firm

Hard

Empt y

Touch/ pain/ pressure sensation Limb length measurement

True length Apparent length

Strength of crutch muscles (in lower limb fracture) Respiratory assessment (post surgical)

Berating pattern Chest wall movement Any signs of infection (sputum with yellow colour)
Scar type Scar length Location

Scar assessment

Assessment of posture Assessment of gait (in lower limb fracture) Examination of ADL

PROBLEM LIST

Pain Edema Reduced ROM Reduced muscle power Muscle wasting Deformity/ tightness Abnormal scarring Chest complication (post surgery) Change in posture Gait disturbance Difficulty ADL Psychological problem

GOALS

Short term goal

To

reduce pain To reduce edema To normalize muscle power To prevent muscle wasting To prevent/ reduce tightness To prevent deformity To prevent chest complication

Long term goal

To

correct deformity To correct posture To correct gait To improve ADL To give psychological support to he patient