Case 4 – Femoral fracture

A patient was referred to you for treatment of Right femoral fracture. Upon OI, patient’s cast has been
removed and atrophy of the muscles are evident.

Guide Questions

1. Given the case, what are the other crucial things that you might need to know before applying
a modality? (Apply your knowledge on PT Eval, give a possible subjective findings and
objective findings that you are going to check)

Subjective findings: The pt. may experience the following symptoms such as pain on the right hip,
weakness, difficulty in ambulation, and decreased activity tolerance/endurance.

Objective findings:

Observation/Inspection/Palpation: Check for soft tissue tenderness, inflammation/swelling, and

pressure sores.

Vital signs: Check popliteal and pedal pulses. Pulse rate and blood pressure should be done before,
during, and after the treatment.

Pain: Check using VAS.

2. What are the current evidences for US application regarding the case? State your references.

The use of therapeutic ultrasound treatment promotes healing of the bone depending on the
intensity used. Several studies conducted that ultrasound application on fractures has been a
contraindication due to high intensity continuous wave ultrasound used. In most recent cases, low
intensity pulsed ultrasound promotes fracture healing.

Kamath JB, Jayasheelan N, Reddy B, Muhammed S, Savur A. The effect of low-intensity pulsed
ultrasound therapy on fracture healing. Muller J Med Sci Res [serial online] 2015 [cited 2020 Mar
17];6:49-53. Available from: http://www.mjmsr.net/text.asp?2015/6/1/49/146426

3. Given that the patient is clear for US application, what parameters will you use? State your
references. (You may search our usual references, or you may search a journal/article
regarding the most effective parameters for fractures)

A systematic review and meta-analysis study concludes that the use of low intensity pulsed ultrasound is
effective especially applied 3-6 months after the surgery. Using a 3 MHz frequency with an intensity of
0.5 W/cm2 is applied on the right femoral fracture with 5-10 minutes of time duration.

Leighton, R., Watson, J. T., Giannoudis, P., Papakostidis, C., Harrison, A., & Steen, R. G. (2017, July).
Healing of fracture nonunions treated with low-intensity pulsed ultrasound (LIPUS): A systematic review
and meta-analysis. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28532896
4. Given that the patient is cleared for exercise, what are the possible exercises that you may give
to patients with femoral fractures? State your references.