Guest guest Posted June 24, 2012 Report Share Posted June 24, 2012 I have a case of a comminuted fracture of a femur and it had come to me after 3 surgeries and about 3 weeks after the fracture happened. Now ther is a lot of metal in the bone, cerclages, a bone plate and an intramedular pin. The surgeon is afraid about no union of the bone and I am also afraid about a cuadriceps contracture. The dog is a 10 year old some kind of terrier on his genes. All I have as modalities are NMES, TENS and a PEMF blanket from Respond Systems. I may get a laser borrowed from a friend or an ultrasound, but that is not sure. What do you recommend the best for this case, I´ve read the PEMF may be good, but how often and in how many HZ do you recommend? If I get the laser how often and in which order do I apply the different modalities? If I can also get an ultrasound is it ok to do both the ultrasound and the laser? How useful may be the NMES, or is it contraindicated because the last surgery has been about 10 days ago? Or I don´t know if to consider this as an unstable fracture? Please help, this is my first case of this type. Thanks Islas, DVM, CRI student Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 26, 2012 Report Share Posted June 26, 2012 Hello !Okay - so to answer your question. Since there has been surgical fixation, the fracture should hopefully be considered stable. And since the dog is 10 years old, hopefully you won't run into a quadriceps contracture (as they tend to occur in juvenile dogs).PEMF I would use at 15Hz x 30 minutes / session (or longer if you have the dog or the owners have your PEMF bed).Ultrasound, I would use at 0.05W/cm2, 50% pulsed, 10 - 15 minutes / session - every second day, or daily for 10 days.Laser, I would use at about 4 - 8 J/cm2, and cover the entire area/region overlying the fracture site, daily for 2 weeks, or as often as you can if not daily.E-stim, I would place the electrodes above the fracture site, 4pps, 15sec on / 15 sec off, x 30 minutes / session (i.e put it on first and do all your other treatments while it's on).Do ROM (stifle flexion) and if the ROM starts to deteriorate, you may need to bandage the leg up into flexion for periods of time during the day or night - or both if it looks like a contracture is occurring.And when everything seems to be doing okay - after a week or so, I'd start doing some weight bearing / weight shifting exercises.All the best!!! You'll do great !Laurie Laurie Edge-, BScPT, MAnimSt (Animal Physio), CAFCI, CCRTCEO,Four Leg Rehab Inc.Canine Rehab Educational Resourceswww.fourleg.comCheck it out!! I have a case of a comminuted fracture of a femur and it had come to me after 3 surgeries and about 3 weeks after the fracture happened. Now ther is a lot of metal in the bone, cerclages, a bone plate and an intramedular pin. The surgeon is afraid about no union of the bone and I am also afraid about a cuadriceps contracture. The dog is a 10 year old some kind of terrier on his genes. All I have as modalities are NMES, TENS and a PEMF blanket from Respond Systems. I may get a laser borrowed from a friend or an ultrasound, but that is not sure. What do you recommend the best for this case, I´ve read the PEMF may be good, but how often and in how many HZ do you recommend? If I get the laser how often and in which order do I apply the different modalities? If I can also get an ultrasound is it ok to do both the ultrasound and the laser? How useful may be the NMES, or is it contraindicated because the last surgery has been about 10 days ago? Or I don´t know if to consider this as an unstable fracture? Please help, this is my first case of this type. Thanks Islas, DVM, CRI student Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 27, 2012 Report Share Posted June 27, 2012 Hi Laurie!Thanks a lot for your advices. It´s always difficult to start working the theory into practice.Have a wonderful weekTo: VetRehab From: physio@...Date: Mon, 25 Jun 2012 21:12:58 -0600Subject: Re: Femur fracture rehab Hello !Okay - so to answer your question. Since there has been surgical fixation, the fracture should hopefully be considered stable. And since the dog is 10 years old, hopefully you won't run into a quadriceps contracture (as they tend to occur in juvenile dogs).PEMF I would use at 15Hz x 30 minutes / session (or longer if you have the dog or the owners have your PEMF bed).Ultrasound, I would use at 0.05W/cm2, 50% pulsed, 10 - 15 minutes / session - every second day, or daily for 10 days.Laser, I would use at about 4 - 8 J/cm2, and cover the entire area/region overlying the fracture site, daily for 2 weeks, or as often as you can if not daily.E-stim, I would place the electrodes above the fracture site, 4pps, 15sec on / 15 sec off, x 30 minutes / session (i.e put it on first and do all your other treatments while it's on).Do ROM (stifle flexion) and if the ROM starts to deteriorate, you may need to bandage the leg up into flexion for periods of time during the day or night - or both if it looks like a contracture is occurring.And when everything seems to be doing okay - after a week or so, I'd start doing some weight bearing / weight shifting exercises.All the best!!! You'll do great !Laurie Laurie Edge-, BScPT, MAnimSt (Animal Physio), CAFCI, CCRTCEO,Four Leg Rehab Inc.Canine Rehab Educational Resourceswww.fourleg.comCheck it out!! I have a case of a comminuted fracture of a femur and it had come to me after 3 surgeries and about 3 weeks after the fracture happened. Now ther is a lot of metal in the bone, cerclages, a bone plate and an intramedular pin. The surgeon is afraid about no union of the bone and I am also afraid about a cuadriceps contracture. The dog is a 10 year old some kind of terrier on his genes. All I have as modalities are NMES, TENS and a PEMF blanket from Respond Systems. I may get a laser borrowed from a friend or an ultrasound, but that is not sure. What do you recommend the best for this case, I´ve read the PEMF may be good, but how often and in how many HZ do you recommend? If I get the laser how often and in which order do I apply the different modalities? If I can also get an ultrasound is it ok to do both the ultrasound and the laser? How useful may be the NMES, or is it contraindicated because the last surgery has been about 10 days ago? Or I don´t know if to consider this as an unstable fracture? Please help, this is my first case of this type. Thanks Islas, DVM, CRI student Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.