Extremity&Hip Fx Flashcards
(111 cards)
1
Q
Q: What type of Salter-Harris Classification is not often recognized at the time of injury?
A
Type 5
1
Q
T/F: ORIF appears to have better outcomes than HA.
A
False, flip it
2
Q
Q: Greater initial displacement = ?
A
More extensive
3
Q
Q: What is the femoral shaft healing time for the following ages? Birth, 8 yo, 12 yo, 20 yo
A
3 wks, 8 wks, 12 wks, 20 wks
3
Q
Q: What are the 3 signs of acute compartment syndrome?
A
- Painful
- Edematous, tight
- Absent or significantly diminished pulse
3
Q
Q: Which stages of the Garden Staging System require surgery?
A
2-4, however, by the time we see them all the stages will look the same to us
3
Q
Q: What population is ORIF suggested for?
A
Younger, highly active pts
4
Q
Content: 3 types of intracapsular fractures
A
- Subcapital 2. Transcervical 3. Basicervical
5
Q
Q: What is the approx. incidence of hip fractures per year?
A
329,000`
5
Q
Q: Acute delirium occurs in _________% of post-op pts.
A
30-50
6
Q
Q: ________% of survivors fail to recover to prior functional status within 1 year of injury.
A
26-75
7
Q
Content: 4 factors of bone healing
A
- Age
- Location and configuration
- Extent of initial displacement
- Blood supply
8
Q
Content: DVT (3)
A
- Very common complication of hip fracture
- Incidence of up to 60% w/o prophylaxis
- Incidence of 20-30% w/prophylaxis
10
Q
Q: What can cause an avulsion fracture?
A
Musculature is stronger than the developing bone can handle
10
Q
Q: What is the failure rate of ORIF?
A
20-36%
11
Q
Q: What can be seen radiographically during the reparative phase?
A
Fracture line diminishes
12
Q
Content: 3 indications for a conservative treatment plan for fracture management
A
- Unstable medical status
- Non-displaced fractures
- Risk of surgery vs. risk of immobility
13
Q
T/F: THA is never used to revise a failed ORIF or HA.
A
False, often
14
Q
Content: 6 ways fractures are described
A
- Anatomic location
- Fracture location
- Direction
- Alignment
- Articular involvement
- Open/Closed
14
Q
Content: 4 Stages of the Garden Staging System
A
1 = incomplete, may be impacted
2 = complete, non-displaced
3 = complete, partially displaced
4 = complete, fully displaced
15
Q
Q: Remodeling is _____ ________ in children and _____________ _____________ after early adulthood.
A
Very, rapid, relatively, constant
15
Q
Q: Non-displaced fractures with ________ periosteal sleave heal _______ as fast as displaced fractures.
A
Intact, twice
15
Q
Q: Presence of a comorbidity increases mortality by ~____%.
A
16
16
Q
Diagram: Identify the type of fracture
A
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
Transverse
46
Diagram: Identify the type of fracture
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
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
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
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
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
Comminuted
82
T/F: The vast majority (90%) of hip fractures occur due to trauma.
False: falls
83
Diagram: Risk factors for falls
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
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
Impacted
