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)
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
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).
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)
what is fracture communion?
- multiple fracture fragments (usually from high-energy fractures)
what is multi-trauma?
- when multiple systems are involved (ie MSK, CNS, cardioresp etc)
what are the 5 p's for presentation of acute fractures?
*each of these should be assessed if fracture is suspected
- pallor (discoloured/pale)
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
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
what are some MSK complications associated with fractures?
- 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!)
describe non MSK complications associated with #s
*prevalence directly associated w degree and duration of period of immobilization
- atelectasis (collapsed lung)
- pressure sores
- pneumothorax (air in pleural space)
- thromboembolic event (deep vein thrombosis, pulmonary embolism, embolic cerebrovascular accident)
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)
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)
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
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
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)