Principles of orthotics pt 2 & Orthosis in PT

Question 1

Early in the middle life period, both _____________and _______________
enter a period of gradual ________________ _______________ loss that
appears to be ________________ determined.

Answer 1

-both men and women
- gradual endochondral bone loss
- genetically determined

Question 2

List factors that influence the rate of bone loss

Answer 2

• hormonal status
• nutrition
• smoking
• alcohol use
• activity level

Question 3

Which population has the greatest vulnerability to bone fracture?

Answer 3

• postmenopausal women

Question 4

For which conditions are hip orthoses indicated?

Answer 4

• inadequate development of acetabulum and head of femur
• avascular necrosis of femoral head and inadequate blood supply to it
• loss of cartilage and abnormal bone deposition (OA)
• loss of bone strength and density in osteoporosis
• developmental dysplasia of the hip
• Legg-Clave Perthesis disease
• recurrent hip dislocations

Question 5

List two important functions of the hip

Answer 5

1. must support weight of head, arms, trunk during functional activities
2. effectively transmit forces from pelvis to LE during quiet standing, gait, and CC activities

Question 6

The proximal femur, comprised primarily of trabecular bone, is designed to
withstand significant ________________while also permitting
_______________
through large excursions of ___________________

Answer 6

• loading
• permitting movement
• excursions of ROM

Question 7

How long does clinical union of a fracture take in the repair phase post
injury and what is recommended during this timeframe?

Answer 7

up to 3 months post injury
- long period of immobilization recommended

Question 8

How long does the process of callus maturation last, particularly with
complex fractures?

Answer 8

1 yr +

Question 9

What are intertrochanteric fractures?

Answer 9

extracapsular, linear, oblique, through or between the trochanters

Question 10

How are fractures of the pelvis classified?

Answer 10

stable or unstable

Question 11

What are persons with unstable fractures of the pelvis at risk for?

Answer 11

• life threatening hemorrhage
• residual genitourinary or neurological complications

Question 12

What is a pathological fracture?

Answer 12

• occur when there is an underlying disease that compromises bone density or metabolism
  (osteoporosis, charcot osteopathy, neoplasm)
• trabeculae overwhelmed by magnitude of force exerted through bone and bone is compressed and fractured

Question 13

What factors/issues does the orthopedist consider when choosing an
appropriate immobilization strategy?

Answer 13

1. stability of fracture site and how well a device can maintain fracture reduction to achieve desired anatomical result
2. Limb volume: how will limb size change overtime in device
3. Length of immobilization time: short term vs long; removable for hygiene?
4. Availability

Question 14

What are 2 reasons a bent knee cast is chosen for immobilization?

Answer 14

• when non-weight bearing for ambulation
• to aid in controlling rotation of the tibia

Question 15

What are custom-fabricated/fit fracture orthoses designed to do?

Answer 15

• maintain a body part in optimal anatomical position,
• limit joing motion,
• unload weight bearing forces.

Question 16

What is the major advantage of fracture orthoses vs cast brace?

Answer 16

orthosis can be removed for wound or skincare

Question 17

What might be added to an AFO fracture orthosis to compensate for
limited heel, ankle and toe rocker motion during gait?

Answer 17

• cushion heel and rocker sole

Question 18

What structures of the distal LE require adequate clearance of the trimlines of an AFO fracture orthosis?

Answer 18

• head of fibula
• peroneal nerve

Question 19

What does a PTB fracture orthosis do for the tibia during weight bearing activities?

Answer 19

protection from bending and rotatory torque for the tibia during weight bearing activities

Question 20

What is the purpose of a knee/ankle/foot fracture orthosis?

Answer 20

• long term protection for fractures of the distal to middle femur or for fractures about the knee

Question 21

If axial unloading is desired (loading of the femur, tibia, foot) what must be used to achieve this during ambulation with a fracture orthosis?

Answer 21

assisted devices (crutches or walkers)

Question 22

What type of device is used when the fracture disrupts pelvic stability?

Answer 22

external fixation devices

Question 23

In what period of time after a fracture or dislocation must the blood supply and nutrition to the distal muscle and bone be restored before significant
tissue death occurs?

Answer 23

less than 6-8 hours

Question 24

-Name one of the most important considerations for LE fractures regarding
mobility.

Answer 24

• weight bearing status