Injury Fractures (tibia, fibula)

Predisposing factors such as posture, alignment, age, gender, somatotype

Predisposing factor 1.

1. Age
2. Calcium deficient

3. Common in toddlers

Cause(s) - Mechanism of Injury.
1. Direct Blow
2. Fall

3. Motor Vehicle Accidents
4. Directional or rotational

Presentation
1. Presents with pain on site of injury.

2. Obvious deformity

Signs and Symptoms

1. Obvious deformity
2. Swelling
3. Shortening of leg
4. Rotation below the fracture site
5. Angulation
6. Pain over the injury site
7. Bruising

Examination and evaluation procedure
Palpation

1. Palpate on, above, and below the injured site
2. Feel for swelling
3. If patient can move the leg check for crepitus.
4. Edema
5. Effusion
6. Point tenderness



Range of Motion

1. Check for limited or no ROM

2. Painful ROM
3. If bone is broken crepitus will occur with movement


Reduction procedure(s) (if applicable)
1. Splint Injury as it lies

2. Some Athletic Trainers will put the fracture back into place.
3. If the fracture is cutting of distal pedal pulse, than one must reduce the fracture

Referral/Diagnostic Procedure
1. X-rays

2. MRI
3. If surgery is needed refer to orthopedic surgeon

Treatment and Management
1. RICE until confirmation of fracture

2. Most patients will be placed in a cast or another immobilization for 4-8 weeks
3. No weight bearing activities

Special emergency considerations (if applicable)
1. Check distal pedal pulse to ensure the bone is not cutting any veins/arteries

2. If it is an open fracture, splint as it lies and send the athlete to the emergency room
3. Circulation

Exercise 1.

1. Straight leg raises- 4 planes

2. Quad sets
3. Heel slides
4. Light jogging
5. Hamstring curls

Protection 1.
1. Patient may be required to wear protective materials such as shin guards.
















Injury (Metatarsals, Tarsal fractures)

Predisposing factors such as posture, alignment, age, gender, somatotype

Predisposing factor 1.
1. Age

2. More common in females
3. Morton’s toe
Cause(s) - Mechanism of Injury


1. Direct Blow
2. Twisting
3. Dropping a heavy object on foot


Signs and Symptoms
1. Pain

2. Swelling
3. Bruising
4. Point tenderness
5. Painful weight bearing activities
6. Limited or no ROM

Examination and evaluation procedure
Palpation

1. Point tenderness
2. Edema
3. Crepitus
4. Feel for swelling
5. Check distal pedal pulse


Range of Motion
1. Limited or no ROM
2. Painful ROM

Reduction procedure(s) (if applicable)
1. Splint injury as it lies

2. RICE

Referral/Diagnostic Procedure
1. X-rays

2. Refer to orthopedic specialist if x-ray is positive.
3. It may take up to two weeks for a fracture to appear on x-ray. If x-ray is negative one may consider getting another x-ray in two weeks.

Classification
1. Simple
2. Torg
3. Stewart
4. Zonal
5. Acute



Treatment/management
1. RICE

2. Immobilization
3. Casting
4. Rehab



Special emergency considerations (if applicable)
1. If fracture is open, splint as it lies and send to the ER

2. Check distal pedal pulse, if pulse is dim or no pulse at all reduce the fracture so the pulse will return.

Consideration

1. Consider if the patient has open growth plates

Rehabilitation
1. Marbles

2. Exercises that enhance plantarflexion, dorsiflexion, inversion and eversion
3. Theraband
4. Active and passive ROM
Protection 1.
1. Extra padding where the injury occurred. May need brace

2. Work on balance, it will help prevent some injuries
























Injury
Stress fracture (tibia, fibula, metatarsals)

Predisposing factors such as posture, alignment, age, gender, somatotype
1. Runners

2. Overuse
3. Shoes
4. “Texture” of the ground that the athlete plays on


Cause(s) - Mechanism of Injury
1. Overuse

2. Improper shoes
3. Improper training
4. Bone fatigue
5. Repetitive use


Signs and Symptoms
1. Swelling

2. Point tenderness over a specific place
3. Increased pain and swelling with activity
4.
5.
Examination and evaluation procedure
Palpation

1. Palpate on and around the pain
2. Palpate the amount of edema
3. Look for specific places along the tibia and fibula that cause pain
4. Palpate for non- obvious deformity

2. Range of Motion



ROM

1. There is usually no limited ROM.

2. ROM is painful however Classification (if applicable) 1. Schatzker



Referral/Diagnostic Procedure
1. X-ray

2. MRI
3. Bone scans

Treatment/management

1. Rest
2. Ice
3. Compression
4. Elevation
5. Limit exercise, if severe remove athlete from play for up to 4 weeks
6. Therapy
7. NSAID’s
7. Surgery is sometimes necessary however it is not common

Rehabilitation
1. Rest is the best way to treat stress fractures

2. Strengthen the gastrocnemius
3. Quad strengthens

Protection & Other Return to Competition Factors
1. Shin guards

2. Get proper nutrition



Injury

Jones Fracture

Predisposing factors such as posture, alignment, age, gender, somatotype 1. Osteoporosis

2. Common in elderly and adolescents

3. Usually only occurs in athletes Cause(s) - Mechanism of Injury 1. Twisting mechanism

2. Common with ankle sprains

3. Forceful weight such as a jump from a high altitude Signs and Symptoms 1. Pain

2. Swelling

3. Difficulty walking

4. Abnormal gait swings

5. Point tenderness

6. Pain with weight bearing activities Examination and evaluation procedure E. Palpation 1. Point tenderness

2. Feel for crepitus

3. Check for a non obvious deformity

4. Palpate on, above and below the injury site 2. Range of Motion 1. Patient will present with little to no ROM

2. Painful ROM

-plantar flexion

-dorsiflexion

-eversion

-inversion Classification (if applicable) 1. It is as type of a metatarsal fracture

Reduction procedure(s) 1. Splint foot as it lies

2. Check distal pedal pulse

Referral

1. X-ray

2. Bone scan

3. MRI

4. If surgery is necessary athlete will need to see an orthopedic surgeon

Treatment and Management 1. RICE 2. Immobilization

3. Some cases may require surgery

Rehabilitation 1. Theraband

2. Marbles

3. Wobble board

4. ROM motion exercises Protection & Other Return to Competition Factors 1. Many athletes must have their ankle taped once they return to play