Lecture Fractures Flashcards Preview

PT - Ortho Class 1 > Lecture Fractures > Flashcards

Flashcards in Lecture Fractures Deck (16):
1

What are the 3 typs of external fixation?

1) Monolateral (screws placed above and below #, device realigns bone)

2) Circular (rings can be manipulated individually in 3 planes)

3) Lizarov technique (for "growing" bone that was removed)

2

what is the GENERAL pt management for fractures?

- must know the surgical procedure, structures involved, anatomy, respect stages of tissue healing

- generally for ROM: PROM -> AAROM -> AROM

- generally for strength: Isometric (neurtral -> diff angles) -> concentric -> eccentric -> functional *always pain free!

- proprioception and balance exercises when appropriate

3

define: subluxation

Displacement of the bones at a joint that goes beyond the normal movement allowed at the joint, but such that the articular surfaces remain partly in contact (a partial dislocation).

4

what s incidence vs prevalence?

Incidence = risk of something (rate of occurance of new cases)

Prevalence = how widespread something is (proportion of cases in pop at a given time)

5

what is fracture communion?

- multiple fracture fragments (usually from high-energy fractures)

6

what is multi-trauma?

- when multiple systems are involved (ie MSK, CNS, cardioresp etc)

7

what are the 5 p's for presentation of acute fractures?

*each of these should be assessed if fracture is suspected

- pain

- paralysis

- paresthesia

- pallor (discoloured/pale)

- pulselessness

8

describe primary vs secondary bone healing

primary: from rigid immobilization

-no appearance of fracture callus

-lamellar (mature) bone at areas in direct contact, woven (immature) bone between fragments which is later remodeled to lamellar bone

secondary: immobilization allowing for some strain at # site

-hematoma first formed, then fibrous tissue developed, the cartilage layer spanning # site, then fracture callus, then woven bone which remodels into lamellar bone

9

What are the clinical stages that a healing fracture progesses through?

1) union (3-10 weeks) - described by evidence of initial callus formation (# line still visible), # site must still be protected - no FWB still for LE #

2) "clinical" union - callus shows clear evidence of calcification, immobilization terminated, # site stabe and no movement under minimal stress, *PT involved at this stage!

3) consolidation - (2 times as long as union phase) # considered "fully healed", no # line visible, no movement at # site, full functional use resumed

4) remodelling - (takes twice as long as consolidation), bone has returned to pre-fracture state

10

what are some MSK complications associated with fractures?

- infection

- fixation failure (problem with instrumentation)

- neurovascular compromise/injury

- malunion (bone deformities as # site reaches union)

- delayed union or non-union (6-8 months for non-union)

- post-traumatic arthritis

- stiffness/ loss of ROM

- osteonecrosis (typically due to associated vascular injury - bone cannot heal itself further and therefore susceptible to fatigue damage, stress #s etc)

- heterotopic ossification/myositis ossification (development of bone where there should not be bone)

- complex regional pain syndrome (pain associated with abnormal automatic nervous system activity and trophic changes)

- acute compartmet syndrome (increasd pressure in enclosed space - limb-threatening condition!)

11

describe non MSK complications associated with #s

*prevalence directly associated w degree and duration of period of immobilization

- atelectasis (collapsed lung)

- pneumonia

- pressure sores

- UTIs

- pneumothorax (air in pleural space)

- thromboembolic event (deep vein thrombosis, pulmonary embolism, embolic cerebrovascular accident)

12

what are the ottawa knee rules?

*send for xray if acute knee injury and at least one of the following:

- over 55 yo

- tenderness at fibular head

- tenderness at patella

- inability to flex to 90 deg

- inability to WB 4 steps (immediately and in ED)

13

describe in order the interventions for improving loss of knee flexion

1) agressive PT 6-8 weeks

2) manipulation under anesthesia

3) athroscopic lysis of adhesions

4) indwelling epidural anesthesia, CPM and intensive PT

5) quadricepsplasty (if failure to progress in 8-12 months)

14

ottawa ankle rules 

ankle xray following acute injury if pain in malleolar zone and at least one of:

- bone tenderness at posterior edge or tip of lateral malleolus

- bone tenderness at posterior edge or tip of medial malleolus

- inability to WB immediately and in ED

15

ottawa ankle rules for foot xray

foot xray following acute injury if pain in midfoot and at least one of:

- bone tenderness at base of 5th meditarsal

- bone tenderness at navicular

- inabiity to WB immediately and in ED

16

for intramedullary nailing, what is the anterograde vs retrograde approach?

anterograde: nail enters through proximal femur (associated with more hip complications)

retrograde: nail enters through distsl femur (assocaited with more knee complications)