Fracture Management for the Hand and Upper Limb Therapist


About the Course 

Fracture management is constantly evolving as new therapy techniques are developed and surgical stabilization methods change. University curriculum rarely provides up-to-date training in management of upper extremity (UE) fractures.  This course prepares the beginning and intermediate therapist to successfully treat patients with upper extremity fractures and associated injuries using current research and case studies.  This course presents the physiology of bone healing, reviews relevant anatomy, explains pathology using models and x-rays, and describes surgical procedures and therapy protocols currently in use to lay a foundation for clinical decision making. Discussion of therapeutic interventions used to restore function includes orthotic fabrication, manual therapy techniques, sensorimotor training, modalities, resistive exercises and functional training. 

Learning Outcomes

Upon completion of the course, the learner will be able to:  

  • Compare and contrast primary bone healing and secondary bone healing as they relate to timelines for advancing therapy protocols. 
  • Recognize one clinical sign of fracture healing.
  • Identify causes of fracture nonunion. 
  • Describe the effects of early controlled motion on fracture healing. 
  • List conditions that can be seen on radiographs and other imaging methods.
  • Identify complications to watch out for in a patient who has had a closed reduction with percutaneous pinning.  
  • Explain how an external fixator influences fracture healing. 
  • Compare and contrast the benefits and risks of open reduction internal fracture fixation vs closed reduction external support to the therapy program.
  • Explain how dorsal hand and wrist edema can lead to delays in regaining function and permanent functional deficits.  
  • Identify edema management techniques.
  • Explain how the use of a safe position orthosis can influence the amount of post-fracture therapy needed and a patient’s ultimate function.  
  • Identify complications that can occur during fracture rehabilitation and explain how these complications can significantly affect functional outcome. 
  • Identify special considerations for pediatric fractures.
  • Identify signs that scars are adhered to underlying tendons.
  • Explain how graded motor imagery can be used to improve patients’ function.
  • Explain how mirror box therapy can improve function.
  • Explain the therapeutic effect of low load prolonged stress on contractures.
  • Explain how early controlled motion can positively affect functional outcome.
  • Explain how the blood supply of the scaphoid contributes to fracture nonunion.
  • Recognize the progression from a scaphoid nonunion to an advanced scapholunate collapse. 
  • Recognize problems in the design of an orthosis that will lead to contractures and skin problems.
  • Explain why patients feel ulnar wrist pain with distal radius shortening after a fracture. 
  • Explain why patients who have ulnocarpal impaction may complain of a greater amount of pain when gripping with the forearm pronated. 
  • Explain why an EPL tendon might rupture over a distal radius fracture.
  • Explain why restoration of normal wrist motion might not be the most appropriate goal for a 90-year-old following closed reduction and healing of a distal radius fracture. 
  • Identify injuries that are commonly associated with intra-articular distal radius fractures.
  • Explain why one might choose to start wrist AROM in the dart thrower’s plane of motion.
  • Describe a grip activity modification for healing TFCC repairs.
  • Recognize which types of strengthening exercises are best suited to different applications.
  • Identify proper positioning of fractured or fractured and dislocated joints within an orthosis to protect all healing structures.
  • Identify sensorimotor impairment and recognize treatment interventions to alleviate it.
  • Describe 3 techniques for addressing scar adherence that limits tendon excursion.
  • Identify 4 techniques for addressing IP extensor lags.
  • Describe how vascularity effects mallet orthosis failure rates and identify 3 ways to mitigate risk of skin breakdown.
  • Identify 3 proprioceptive training exercises for the thumb.

About the Author/Presenter

Susan Mitchell, MS, OTR/L, CHT has worked closely with onsite hand surgeons and other medical staff to provide quality care to patients with upper extremity disorders for over 25 years. Other accomplishments include collaboration on a research study published in Orthopedics journal in April 2006, authoring a chapter on extensor injuries in ASHT's Test Prep for the CHT Exam (3rd edition) and numerous speaking engagements on topics ranging from ergonomics to splint fabrication to extensor tendon management.  

How to Receive Credit

  • View the entire recording which requires a 10-hour commitment of time.
  • After completion of the course, complete the final examination. A passing grade of 75% is required. Test questions link content to learning outcomes as a method to enhance individualized learning and material retention.  
  • Note to Nursing professionals: Depending on your state requirements, you will be asked to either affirm that you have completed the course, or you will be required to complete the Post-test included in the course.
  • Provide required personal information and payment information.
  • Complete the mandatory course evaluation.
  • Print your Certificate of Completion. 

Resolution of Conflict of Interest*  

Planners, faculty, and others in control of content (either individually or as a group) have no relevant financial relationships with ineligible companies.

Sponsorship/Commercial Support and Non-Endorsement

It is the policy of Colibri Healthcare, LLC not to accept support from ineligible companies. Furthermore, ineligible companies are prohibited from distributing or providing access to this activity to learners.


The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.  

©2023: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge of the areas covered. It is not meant to provide medical, legal, or professional advice. Colibri Healthcare, LLC recommends that you consult a medical, legal, or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing but does not represent or warrant that it will apply to your situation nor circumstances and assumes no liability from reliance on these materials. Quotes are collected from customer feedback surveys. The models are intended to be representative and not actual customers.? 

Accreditations and Approvals

Colibri Healthcare, LLC is an AOTA Approved Provider of professional development (Provider #9118). The assignment of AOTA CEUs does not imply endorsement of specific course content, products, or clinical procedures by AOTA or indicate AOTA approval of a certification or oth