Extremity&Hip Fx Flashcards Preview

PTRS 746 Exam 1 Combined and Randomized > Extremity&Hip Fx > Flashcards

Flashcards in Extremity&Hip Fx Deck (111):
1

Q: What type of Salter-Harris Classification is not often recognized at the time of injury?

Type 5

1

T/F: ORIF appears to have better outcomes than HA.

False, flip it

2

Q: Greater initial displacement = ?

More extensive

3

Q: What is the femoral shaft healing time for the following ages? Birth, 8 yo, 12 yo, 20 yo

3 wks, 8 wks, 12 wks, 20 wks

3

Q: What are the 3 signs of acute compartment syndrome?

1. Painful

2. Edematous, tight

3. Absent or significantly diminished pulse

3

Q: Which stages of the Garden Staging System require surgery?

2-4, however, by the time we see them all the stages will look the same to us

3

Q: What population is ORIF suggested for?

Younger, highly active pts

4

Content: 3 types of intracapsular fractures

1. Subcapital 2. Transcervical 3. Basicervical

5

Q: What is the approx. incidence of hip fractures per year?

329,000`

5

Q: Acute delirium occurs in _________% of post-op pts.

30-50

6

Q: ________% of survivors fail to recover to prior functional status within 1 year of injury.

26-75

7

Content: 4 factors of bone healing

1. Age

2. Location and configuration

3. Extent of initial displacement

4. Blood supply

8

Content: DVT (3)

1. Very common complication of hip fracture

2. Incidence of up to 60% w/o prophylaxis

3. Incidence of 20-30% w/prophylaxis

10

Q: What can cause an avulsion fracture?

Musculature is stronger than the developing bone can handle

10

Q: What is the failure rate of ORIF?

20-36%

11

Q: What can be seen radiographically during the reparative phase?

Fracture line diminishes

12

Content: 3 indications for a conservative treatment plan for fracture management

1. Unstable medical status

2. Non-displaced fractures

3. Risk of surgery vs. risk of immobility

13

T/F: THA is never used to revise a failed ORIF or HA.

False, often

14

Content: 6 ways fractures are described

1. Anatomic location

2. Fracture location

3. Direction

4. Alignment

5. Articular involvement

6. Open/Closed

14

Content: 4 Stages of the Garden Staging System

1 = incomplete, may be impacted

2 = complete, non-displaced

3 = complete, partially displaced

4 = complete, fully displaced

15

Q: Remodeling is _____ ________ in children and _____________ _____________ after early adulthood.

Very, rapid, relatively, constant

15

Q: Non-displaced fractures with ________ periosteal sleave heal _______ as fast as displaced fractures.

Intact, twice

15

Q: Presence of a comorbidity increases mortality by ~____%.

16

16

Diagram: Identify the type of fracture

Q image thumb

Spiral

16

Q: What Salter-Harris classification is an injury to perichondrial ring may cause physis to tether to bone, hindering growth?

Type 6

17

Q: Which type of Salter-Harris classification is most common?

Type 2

17

Content: 2 types of fracture reduction

1. Open

2. Closed

19

Content: Late complications - joint (2)

1. Persistent pain or stiffness

2. Post-traumatic DJD

21

Q: What occurs during the reparative phase?

Cell differentiation - chondroblasts are mineralized by osteoblasts to form a soft callus

21

Q: Who is cortical bone more flexible in?

Children

21

Q: Delayed mobilizaiton is associated with... (5)

1. Delirium

2. Pneumonia

3. Increased length of stay

4. Greater 6 mo. mortality

5. Poorer 2 mo functional performance

22

Q: What is the risk during the reparative phase?

Delayed union or non-union

23

Q: What is the risk of dislocation with HA?

~5%

24

Content: Early complications - local (3)

1. Infection, gangrene, septic arthritis

2. Compartment syndrome

3. Osteomyelitis, avascular necrosis

24

Q: What is the single best predictor of operative mortality following hip fracture?

Delirium

25

Q: What 5 things does a PT fracture intervention entail?

1. Preserve/Improve ROM

2. Increase mobility

3. ADL training

4. Education

5. Wound care

26

Q: What 4 things should be considered for a PT fracture intervention?

1. MOI

2. Age

3. Functional needs/demands

4. Type of immobilizaiton/orthopedic plan of care

26

Q: What is the risk of dislocation for a THA?

5-10%

27

Content: 4 goals of fracture management

1. Pain control

2. Reduction and fixation in good position

3. Return to function

4. Prevent complications

28

Term: Femoral head articulates with acetabulum, but is fixed to the stem

Unipolar

29

T/F: Long oblique and spiral fractures heal faster than transverse fractures

True

29

Q: What percent of hip fractures occur in women?

76

30

Content: 5 risk factors for heterotropic ossification

1. Neurologic involvement

2. Open wounds/burns

3. Sepsis

4. Prolonged critical illness

5. Aggressive ROM

31

Q: What are the two main types of fracture management?

Reduction and immobilization 

32

Content: Salter Harris Classification - Type 1 (Description, Tx, Px)

D: run directly along the growth plates, vital portions of growth plate remain attached to the epiphysis

Tx: Rarely reduced, immobilization to fully heal

Px: Excellent if blood supply is intact

33

T/F: Avulsion fractures are more common in children, esp. at growth plates.

True

34

Q: What are the 3 risks associated with posterior THAs?

1. Dislocation

2. Infection

3. DVT

35

Q: A cortical bone fracture caused by an angulatory tension force (in children) is called a?

Greenstick fracture

37

Content: Late complications - bony (5)

1. Abnormal healing

2. Growth disturbance

3. Persistent ostemyelitis

4. Osteoporosis

5. Complex regional pain syndrome (CRPS)

38

Q: What occurs during the remodeling phase?

Reformation of the medullary canal

39

Q: 1 in ____ individuals die within 1 year of a hip fracture.

5

39

T/F: Bipolar replacements are better than unipolar replacements.

False, no evidence that one is better than the other

41

Content: 3 phases of bone healing (with time frame)

1. Inflammatory phase, 1-2 wkls

2. Reparative phase, months

3. Remodeling phase, mo-yrs

41

Q: What is the key to rehab for hip fractures?

Early mobilization

43

Content: Salter Harris Classification - Type 3 (Description, Tx, Px)

D: Run along part of growth plate and turn perpendicularly into the joint

Tx: Surgery to restore joint surface

Px: Good if blood supply to separated portion is intact

45

Diagram: Identify the type of fracture

Q image thumb

Transverse

46

Diagram: Identify the type of fracture

Q image thumb

Depressed

48

Content: Salter Harris Classification - Type 4 (Description, Tx, Px)

D: Run from epiphysis across the growth plate and into the metaphysis

Tx: Surgery to restore joint surface and align growth plate

Px: May cause premature focal fusion and joint deformity 

49

Content: Extracapsular Hip Fracture (2)

1. Involve trochanteric region

2. Types trochanteric, intertrochanteric, subtrochanteric

50

Diagram: Identify the type of fracture

Q image thumb

Avulsion

52

Q: Periosteal sleeve disruption = ?

Prolonged healing time

53

T/F: It is unclear whether cemented or uncemented is the superior approach.

True

55

Q: What is the healing prognosis is all fracture fragments have blood supply?

Excellent

55

Q: ORIF or pinning is thought as _______ ___________.

bone conserving

56

Content: PE (3)

1. Incidence ~10-15%

2. Mortality ~2-10%  

3. Account for 14% of deaths due to hip fracture

58

Q: If only some fragments have blood supply, what is the course of action?

Rigid immoblization to allow for vascularized fragments to serve as "hosts" to unvascularized fragments

59

Q: What is the failure rate of HA?

6-18%

60

Q: Hemiarthroplasty is considered for ______________ fracture.

Intracapsular

61

Q: Delirium is usually observed within POD _____, resolved by POD ___.

1-5, 7

63

Q: Fractures surrounded by __________ heal faster

Muscle

64

Defn: Increased pressure with fasical compartment (esp. anterior LE) due to edema or hematoma within closed space

Acute Compartment syndrome

65

Q: What occurs during the inflammatory phase?

Increased vascularity and formation of fracture hematoma

67

Diagram: Fill in the following table

Q image thumb

A image thumb
68

T/F: THA has better outcomes than HA beyond 3 years.

True

70

Q: How is chronic compartment syndrome different than acute?

Chronic is due to muscular expansion or decreased size of anatomical compartment

70

Content: Salter Harris Classification - Type 2 (Description, Tx, Px)

D: Runs along the grwoth plate and includes a triangular metaphyseal fragment

Tx: Reduction and immobilization

Px: Good

71

Content: Late complications - muscular (2)

1. Myositis ossificans

2. tendon rupture

72

Diagram: Identify the type of fracture

Q image thumb

Oblique

74

Content: Initial complications due to local injuries to... (5)

1. Skin

2. Vascular

3. Neurologic

4. Muscular

5. Visceral

74

Content: Early complications - remote (3)

1. Thrombus/embolus formation

2. Pneumonia

3. Tetanus

74

Diagram: Identify the type of fracture

Q image thumb

Longitudinal

75

Q: With HA you see a deterioration of function after ______ years

3-5

77

Content: 4 types of immobilization

1. Casting

2. Splinting

3. External fixation

4. Internal fixation 

78

Q: What are the 3 risks associated with anterior THAs?

1. Increased operative time

2. Increased blood loss

3. Infection

79

T/F: Falls are the leading cause of death in individuals greater than 65 years old.

True

81

Diagram: Identify the type of fracture

Q image thumb

Comminuted

82

T/F: The vast majority (90%) of hip fractures occur due to trauma.

False: falls

83

Diagram: Risk factors for falls

A image thumb
84

Content: 3 Surgical treatments for hip fracture

1. ORIF

2. HA

3. THA

85

Q: 1 in _____ require nursing home care for at least 1 year.

4

87

Q: What percent of hip fractures result from falls?

90

88

T/F: Cortical bone heals faster than cancellous bone

False, flip it

90

Q: What is the cellular response during the inflammatory phase? (4)

1. Neutrophils 2. Macrophages 3. Phagocytes 4. Osteoclasts

91

Content: Salter Harris Classification - Type 5 (Description, Px)

D: Compression of growth plate results in a growth disturbance

Px: Poor

92

Q: The risk of fracture ____________ every 5 years after the age of 50.

doubles

93

Content: Anterior THA precautions (3)

1. No ABD

2. No (excessive) extension

3. No ER

94

Q: What are the steps in fracture management and which step involves PTs?

Steps: reduction, fixation, restoration of function PT = restoration of function

95

Diagram: Salter-harris classificaiton of growth plate injuries

A image thumb
96

Content: Complications of hip surgery (8)

1. CV

2. Pneumonia

3. Pressure ulcers

4. Delirium

5. UTI

6. Wound infection

7. Depression

8. Malnutrition

98

Content: Intracapsular Hip Fracture (2)

1. Involve femoral head or neck

2. Higher rate of non-union and AVN

99

Content: Heterotropic ossification (3)

1. Soft tissue ossification, usually periarticular

2. most commonly involves hip or knee

3. unknown etiology

101

Q: ORIF is the treatment of choice for _______________ fracture.

Extracapsular

103

Q: THA is considered for _______________ fracture

intracapsular

104

Q: The fracture rate of institutionalized individuals is _____x greater than those in the community.

5-11

105

Content: Posterior THA precautions (3)

1. No ADD past neutral

2. No flexion past 90

3. No IR

106

T/F: With HA only the femoral component is replaced.

True

107

Term: Femoral head articulates with both acetabulum and stem

Bipolar

108

Content: Fracture mechanics - cortical bone (2)

1. Tolerant to compression and shear forces

2. Fractures due ot tension - bending, twisting, pulling

 

109

Q: What 4 factors should be considered when hip surgery is an option?

1. Age

2. Mobility status

3. Mental state

4. Pre-existing bone and joint pathology

110

Q: What type of forces are cancellous bone susceptible to?

Compression forces

111

Diagram: Identify the type of fracture

Q image thumb

Impacted