Exam 1 (wk 1-3) Flashcards

Question

PT management of bone fx

Answer 1

* Joint mob techniques for regaining joint play (gr III and IV) * PNF stretching * decreased AD * 2-3 weeks post op immobilization begin strenghthening * Scar tissue mobilization

Answer 2

Children: 4-6 wks Adolescents: 6-8 wks Adults: 10-18 wks **Malunion**: fx heals in unsatisfactory position resulting in a bone deformtity **Delayed Union**: healting takes longer than normal **Non-union:** the fx fails to unite with a bony union

Answer 3

* check for signs of redness or necrosis along incisions * palpate along incision and note pain, tenderness, and edema * palpate for sx of heat * drainage color and amount * note integrity of incision * check for mobility of scar as it heals

Answer 4

**Sprain:** acute injury usually involving a **ligament** **Gr I**: mild pain, swelling, little to no tear in the ligament **GR II:** Mod pain + swelling, min instability, min-mod tearing, decreased ROM **GR III:** severe pain + swelling, subsantial instability + decreased ROM, complete tear **Strain:** injury involving a **mm or tendon** attaching to bone **GR I:** localized pain, min swelling, TTP **GR II**: localized pain, mod swelling, TTP + impaired motor function **GR III:** A palpable defect of the mm, severe pain, poor motor function

Answer 5

**Diaphysis:** shaft, made of cortical bone containing bone marrow **Metaphysis:** between epiphysis and diaphysis, contains growth place **Epiphysis**: end of bone, filled with red bone marrow

Answer 6

* Unique to pedicatric pop * Type V has worst prognosis SALTR * Slipped, straight across (type 1) * Above (type 2) * Lower (type 3) * Through (type 4) * Ruined or rammed (type 5)

Answer 7

**Greenstick:** break on one side of the bone that does not damage periosteum on other side in bone (seen in peds) **Transverse**: fx at right angle, sheering forces **Spiral:** due to torsion and twisting **Oblique:** due to twisting/torsional forces **Comminuted**: more than 2 fragments **Impacted**: bone fxs into multipled pieces which are driven into each other **Segmenta**l: fragment of bone is present between main fragments **Avulsion**: tension failure from pull of ligament or msc, small chunk of bone gets pulled away from the bone by a tendon or ligament

Answer 8

Grade 1-3 of fx's **Open fx**: penetrated skin **Closed fx**: skin intact

Answer 9

**Blood loss**: primarily in hip/femur, spine, and **pelvis** (greatest loss) **Nerve dmg and vascular compromise soft tissue dmg** **swelling** **Missed fractures**: common a navicular, hip, C7/T1 area, odontoid **Fat embolism** **Infection locally or systemically** **non,mal, delayed union **

Answer 10

**Splinting/casting:** * decrease pain * decreased bleeding * prevent soft tissue injury *PRICE **Reduction**: a fx being reduced is determined by the location of fx, intra-articular fx and age of patient **Stabilization:** Naturally stable fx, splint or cast, traction, internal and external fixation

Answer 11

**Internal fixation** * Allows bone to be kept stable as it heals * Internal fixation devices include pins, needles, screws, plates, and rods that are used to allign and stabilizate bone fragments * Maintains stability of fx and early pt mobility post op * secondary surgery sometimes needed to remove all devices **External Fixation used for** * open wounds secondary to fx * complex/unstable fx's * significant swelling

Answer 12

**Neurologic:** * stretch/contusion of nerves * transection * shoulder dislocations **axillary nerve** is at risk * Humerus fx **radial nerve** is at risk * Hip dislocation **sciatic nerve** is at risk * Spine trauma **SCI** **Vascular:** * Stretch/compression of vessels * Supracondylar humerus fx **brachial artery** is at risk * Knee dislocation **popiteal artery** is at risk * **6 hours**= time frame in which soft tissue death will occur due to a vascular injury leading to an amputation **Amputation:** * Last course of action * secondary to disease and trauma * Occurs more in **LE** compared to UE **Compartment Syndrome**

Answer 13

* Elevated pressure due to bleeding or a tight cast * Obstuction of venous outflow * Msc and nerve necrosis * Common in lower leg and forearm * Can be acute or exertional * Pressure needs to be measured **Treatment**: Fasciotomy * Delayed wound closure- the inability to immediately close a surgical incision created during a fasciotomy **Sx's: The P's** * Pain * Parethesias * Paralysis * Decreased Pulse * Pallor

Answer 14

**Osteomyelitis:** * **Infection within the body** * Staphylococcus auereus (bone infection) * Caused by Compound fx, surgery, puncture wound that penetrates bone * **bone biopsy** used to confirm diagnosis **Tetanus:** * Tetanus bacteria from wounds, dmgs nervous system

Answer 15

**Dry:** * Loss of vascular supply=local tissue death * not painful * can lead to amputation **Wet:** * causd by Bacterial infection, severe burn or untreated wounds * Cessation of bloodflow

Answer 16

* Bolus of coagulated blood in the circulatory system * Venous clot formation (superficial or deep)

Answer 17

**Signs and Sx's** * Wells clinical prediction rule used to determine * Structural and functional impairments: Dull ache or pain in calf, tenderness warmth and swelling with palpation, changes in skin temp and color * Confirmed with ultrasound, venous duplex screening, and venography * Embolus= when a clot breaks away from the wall of a vein **Risk Factors**: * Post-op or post fracture immobilization (total jt replacements) * Prolonged bed rest * sedentary lifestyle, extended episodes of sitting * Prolonged standing greater than **6 hours** * Trauma to venous vessels * Limb paralysis * Active malignancy * Hx of DVT or PE * Obesity * Advanced age * CHF * Oral contraceptives * Pregnancy

Answer 18

* Prophylatic use of anticoagulant therapy * Elevating legs when supine or sitting * Avoid prolonged sitting * initiate ambulation asap * active pumping exercises throughout the day * Use of compression stocking to support walls of veins and minimize venous pooling * Use of pneumatic compresison devices

Answer 19

* Administer anticoagulant meds * best rest, elevate LE, compression stockings * Bed rest is 2 days - one week * Ambulation begins ony when anticoagulant therapy reaches therapueitc levels **Contra**: P or AROM, heat , compression pump **Pre:** avoid contact sports of high fall risk activities

Answer 20

* Possible consequence of DVT, th emoblus travels proximmaly and affects pulmonary circulation * **SX:** - Dyspnea - tachypnea - chest pain - tachycardia - hypoxia - blood in sputum - swelling in LE's - fever * **Dx:** -Ultra sound - CT scan - Blood gas

Answer 21

* Anticoagulation (aspirin, heparing, and coumadin) * Early mobility * Compression therapy * ankle pumps * elevation in sitting and supine

Answer 22

* Seen in sacrum, hip heels * bony prominences

Answer 23

* Casued by **Major/multiple traumas** (femur) * **Bone marrow fat tissue passes into blood stream** and Lodges in vessel and blocks it * Inadequate perfusion * (**1-2) days** post trauma * **Sx** are dyspnea, tachycardia, confusion, and agitation * **Prevention** is early fx stabilization

Answer 24

**Avascular necrosis: **death of bone + bone marrow components as a result of blood loss supply or infection (commonly seen in femoral head, scaphoid, talus, proximal humersu, tibial plateau and post traumatic arthritis)

Answer 25

**Dx**: pain disproportionate to event and no other dx that explains signs + sxs * Commoly caused by surgery or trauma **Type 1**: Noxious event, soft tissue injury, imob. , tight cast, surgery **Type 2**: develops after a nerve injury, edema, skin blood flow abnormality **CRPS NOS**: sx's consistent with CRPS but specific injury not determined * Sensitizes peripheral+ spinal nociceptive pain systems which induces infalmmation resulting in vascular changes

Answer 26

**Dynamic:** affected limb evolves from acute warm pohase (limb is sensitive, swollen and increased temp) * Progress to chronic phase (decreased inflammation, temp, pain) * **Acute Phase-** prominnent peripheral chracteristics * **Chronic phase**- central changes

Answer 27

* Pain/hyperthesia * decreased rom, motor dysfunction * sudomotor/edema (can have sweating asymmetry * **vasomotor instability**: temp assymetry and skin color changes *** Trophic changes:** increased/decreased hair and nail growth or skin changes

Answer 28

* * Pain out of proportion to the original injury **Stage 1:** - pain, swelling, discoloration, and abnormal temp **Stage 2:** -3-4 months post injury, stiffness, and tight skin **Stage 3:** 8-9 months post injury, msc atrophy, contractures, chronic pain **Treatment:** * early recognition and rx * pain relief, edema control * mobilization * sensory re-education, mirror therapy * treatment within 1 year= 80% have significant improvement

Answer 29

* free of disease, trauma aging * many normal painfree backs have normal discs

Answer 30

* Fissure in the annulus due to degeneration, aging or trauma * seen in many people who do not have LBP * Outer 1/3 of the disc is innervated by sinuvertebral nerve and is capable of healing

Answer 31

* generalized displacement of the disc tissue beyond the disc space * Often at L5/S1

Answer 32

Herniation- Protrusion * * The distance between the edges of the herniation is less than the distance at the edges of the base * Can cause back or leg pain * disruption of inner annular fibers with intact outer annular fibers Herniation- Extrusion * distance between the edges of herniation is greater than the distance at the base * often called uncontained disc * results in nerve compression * disrupted annulus with tail of disc material extending into the disc space Herniation- Sequestration * displaced disc material has lost all connection with the disc origin. Pt might feel leg pain only * tail isnt extending into disc space, free fragment that can be reabsorbed

Answer 33

* A portion of the disc projects thorugh the vertebral end plate into the center of the vertebral body * common and seen in minor degeneration of the aging spine

Answer 34

* compression of the cauda equina caused by herniated disc, tumor, spondylosis, absess, compresison fracture * Sx are incontinence, **urinary retention**, saddle anesthesia, loss of tendon reflexes, post void residual urine vol > 100 mL, bowel retention, LE flaccidity, loss of rectal tone * Diagnosed by MRI or CT

Answer 35

Commonly used inaccurate terms for disc disease are * Herniated nucleus pulposus * prolapsed disc * ruptured disc * torn annulus

Answer 36

* episodic back pain stiff in **morning** * spinal jt deformity * painful spinal jt movements * common in **ages 50 +** * "wrinkles on inside" Spondylotic changes: * Loss of disc height/dehyration * facet hypertrophy and off PLL * bone spurs * narrowing of foramen + spinal canal

Answer 37

**def**: degenerative narrrowing of the spinal canal, often **60+** **SX**: lbp, neurogenic claudication (weakening and cramping in legs), * Sx better with **flexed postures** * claudication is due to decreased bloow flow to L/S nerve roots

Answer 38

**Isthmic spondylolithesis:** due to pars fracture or defect, often seen during rapid growth spurts and in **adolosecent athletes,** ( common cause of lbp in adolescents) **Degenerative spondylolithesis:** most common **65+** but can begin after 40. L4 slips on L5 or l3 on l4. * facet becomes hypertrophied and encroach upon spinal canal causing stenosis. * usually grade I or II Grade 1 is 0-25% Grade 2 is 25-50% Grade 3 is 50-75% Grade 4 is 75-100% Grade 5 is over 100% called spondyloptosis, when the vertebrae completely falls off the supportive vertebrae

Answer 39

* **systemic autoimmune disease** * proteins produced by immune system **attack synovial lining** * In the spine it often affects upper C- Spine * Diagnosed by blood tests * Early signs of ra are low grade fever, muscle aches, and fatigue

Answer 40

* reactive sx of SIJ pain and stiffness often begin during **adolescence/early adulthood** * **Risk fx:** family history of AS, frequent GI infections, testing + for the HLA-B27 marker * **Diagnoses** is x-ray and blood work * **Rx** is med and PT

Answer 41

* group of inflammatory autoimmune diseases that affect the spine and joints * ankylosing spondylitis * psoriatic arthritis * irrital bowel disease

Answer 42

* **defect or fx of pars interaticularis usually at L5** * common cause of back pain in **children and adolescents** * will heal with rest * aggravated by **ext and standing** * Diagnosed by oblique angle x-ray. bone scan, CT, MRI

Answer 43

* **suddent onset of BP that increases with standing or walking, pain decreases while lying on back** * limited spinal mobility * Due to osteoporosis, trauma or tumors * **Osteoporotic females older than 50** are at the greatest risk * Traumatic onset seen in 18-25 year olds * most commonly seen **T12-L1** * **Treatment:** bracings, meds, pt, surgery

Answer 44

* **burst fracture of C1** * involves both anterior and posterior arch * usually does **not** result in neurologic compromise * caused by **axial loading** (diving, MVA) * treated with halo brace

Answer 45

* most common type of c2 fx * seen in **young patients and elderely** as a result of **hyperflexion or hyperextension injuries** * **sx** include neck pain and difficulty swallowing due to a potential hematoma * treated with bracing and surgery * Dx: open mouth x-ray

Answer 46

* due to **hyperextension injury** * common in diving, falls mvas * can result in spondylolisthesis of c2 * treated with **stabilization**

Answer 47

* Procedure for herniated discs, portion or all of disc is removed

Answer 48

* alternative to spinal fusion for **disc disease or herniation** * done for pts with disc disease at one level only * not performed on patients with jt or nerve compression

Answer 49

* done for **spinal stenosis ** * **removing of one or both laminae** to reduce pressure on nerves * discetomy is considered a type of decompression

Answer 50

* most commonly performed or spondylolithesis *shows no benefit long term compared to conservative care

Answer 51

* minimally invasive technique to treat compression fx's * kphoplasty involves inserting and inflating a balloon into vertebral body and then filling cavity with cement * vertebroplasty, bone cement is injected under high pressure

Answer 52

* used to treat painful facet joints * involves using radiofrequency to catuerize medial branch nerve * effect can last 2 years

Exam 1 (wk 1-3) Flashcards

(76 cards)