General Priciples Fracture Rehabilitation Flashcards
(31 cards)
Clinical features fractures
Pain Deformity Oedema Muscle spasm Abnormal movements Loss of function Shock Limitation of joint movement Muscle atrophy
What you need to understand about fracture healing
The mechanism of injury- which structures are damaged
How it occurred
Reason for how the patient is managed
Time frames bone and soft tissue healing
Are there any contraindications/complications
Causes of fractures
Trauma
= direct blow weight falling on you
= indirect falling on an outstretched limb
=twisting
=stress or fatigue eg running
Pathological fractures
(health conditions brittle bones)
Complications of fractures
1)Critical blood disorders:
pulmonary embolism deep vein thrombosis
Loose 1.7 litres femoral shaft
2) Fat embolism (acute respiratory distress syndrome)
Bone marrow leaks causes fat globules going into the lungs
3) Skin plaster sores = flakey skin is normal
4) Muscle damage and atrophy
5) compartment syndrome
6) Avascular necrosis
7)problems with union
Delayed union
Malunion
Non union
8) growth disturbance
9) complex regional pain syndrome
Sudecks atrophy
10)intra articular fractures
Osteoarthritis treat early stage
11) visceral injuries
12) adhesions
13) injury to large vessels
14) nerve injuries
15) oedema
16) osteoblasts escape bone cells laid down in muscle fluffy appearance on xray
What is compartment syndrome
If muscles become damaged or inflamed at the time of injury and intramuscular pressure builds up = necrosis and ischemia
High pressure within a closed fascial sheath reduces capillary blood perfusion below level necessary for tissue viability
**anterior tibial muscles or forearm muscles
5 Ps
Pale Pain Pulseless Paraesthesia Paralysed
Split fascia and drain it need a skin graft
Reduction
Realign into normal position or as near to normal anatomical position as possible
Maybe open or closed
May not always be necessary even if there is displacement e.g. clavicle may heal with a bump but function is not restricted
Closed reduction
No surgical intervention is used with fracture being manipulated by hand under local or general anaesthetic
Open reduction
Means that the area has been surgically opened and reduced
Immobilisation aims
Maintain reduction
Provide of the healing environment for fracture
Relieve pain
Methods of immobilisation
Plaster of Paris
Functional bracing (cast bracing)
Internal fixation
Intermedullary nailing
External fixation
Internal fixation
Surgical intervention by applying a plate and screws to the fracture = open reduction and internal fixation
ORIF
Advantages
Detailed inspection accurate surgical assessment
Disadvantages
Causes more trauma more exposure micr
Why does Pain occur after trauma
Immediate from local inflammatory reaction and trauma calls may not be obvious in some cases tenderness on type of fracture once reduced a fracture is painless
Nocisoception
> detect tissue damage/ harmful stimulus
> transport of nocicpetion info along peripheral nerves then in the spinal cord
> interpreted by the brain
Fast pain pathway (0.1 s perception of noxious stimulus) AD fibres
Why does pain occur after surgery
Acute pain aid healing by protecting the injured party by making it hypersensitive to external stimuli
In normal acute inflammatory response:
> Nociceptor activation thresholds are lowered so normal stimuli e.g. touch or movement now produce pain (allodynia)
> Nociceptive input is amplified and response is increased = increase the sensitivity is temporary and protective
How can physiotherapy manage pain in the acute stage
Ultrasound
Acute 0-2 weeks
Pulse 1:4 (20/25%)
1x treatment head x 1:4
TENS
Why does Swelling occur after trauma
Inflammation
What is the normal series of events following acute inflammation.
Vascular
Changes in blood vessel caliber and blood flow
Exudative
Movement of blood plasma to damaged area
Cellular
Immigration of neutrophils and lyokocytes to damaged areas
See inflammation core skills 1
What factors influence this process
X
How can swelling be manages
Ice
Reduced joint ROM early stage 3-4 weeks post opp
Pain at rest or no movement reluctant to move
Swelling physical resistance
Muscle inhibition of joint are swollen
When does movement need to occur
Movements needs to be regained before fibro plastic proliferation of soft tissue healing
Mobilising would be appropriate
Reduced joint ROM later stage
Formation of inextensible fibrous for tissue as part of healing and repair process following associated soft tissue injury in addition to fracture
What other anatomical structures
Core skills 2
What influences the extent of loss of movement after fracture
Extent of tissue injury
Duration of immobilisation healing timeframes
Position of joint whilst immobilised
Patient age
Rehabilitation techniques used
How to minimise loss of range of movement after fracture
Accurate fracture reduction
Controls feeling post injury/surgery
Early movement and possible
Movement off the unsplinted joint
Anticipation of problems proactive rehab
Rehabilitation early stages and general physio role
Get the patient mobile and independent
Maintain ROM in unaffected joint
Maintain muscle strength and extensibility where possible
