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NMSK1 - physio 1 > lower limb fractures - upper femoral > Flashcards

lower limb fractures - upper femoral Flashcards

1
Q

what does NWB mean?

A

non weight bearing

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2
Q

what does PWB mean?

A

partial weight bearing

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3
Q

what does WBAT mean?

A

weight bear as tolerated

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4
Q

what does ORIF mean?

A

open reduction internal fixation - surgery to fix a broken bone by moving it back into place & stabilising it with plates, rods and screws

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5
Q

what does AVN stand for & what is it?

A
  • AVN- avascular necrosis
  • it is the death of bone tissue due to temporary or loss of blood supply to the bones
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6
Q

what does THR vs PHR mean?

A
  • THR= total hip relacement
  • PHR- partial hip replacement
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7
Q

how could the acetabulum be fractured ie what would the MOI involve?

A
  • MOI - force transmitted up the limb
  • eg from RTA, fall on the side, fall from a height
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8
Q

what other conditions could be observed with an acetabulum fracture?

A
  • there may be a hip dislocation
  • there may be sciatic nerve injury
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9
Q

what is conservative treatment?

A

treatment that avoids invasive measures such as surgery, usually with the intent to preserve function

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10
Q

what would conservative management of a acetabulum fracture involve?

A
  • bed rest and traction (straightening bones / relieving pressure on spine or MSK system) for 6 weeks
  • non weight bearing on crutches
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11
Q

what would the surgical management of an unstable acetabular fracture involve?

A
  • surgery would involve ORIF and the pateint being NWB on crutches
  • there would be continuous passive motion to help cartilage healing and ROM
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12
Q

what is continous passive motion (CPM)?

A
  • a therapy that uses a machine to move a joint without the patients effort
  • moves the joint through a controlled ROM that can be adjusted by the physio
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13
Q

How could a posterior dislocation of the head of the femur happen / MOI?

A
  • by a head on RTA
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14
Q

what are the complications of a posterior dislocation?

A
  • damaged sciatic nerve
  • avascular necrosis
  • Osteoarthritis - OA
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15
Q

what are important facts to note about upper femoral fractures?

A
  • common in the elderly
  • risk is higher in females rather than males
  • there may be an associated co-morbitity (presence of 1 or more additional conditions along with the primary one)
  • mortality is 15-36% in the first year
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16
Q

what artery supplies the head of the femur?

A
  • a branch of the obturator artery
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17
Q

in what 2 ways are upper femoral fractures classified?

A
  1. intracapsular- high fracture within the capsule, fracture interupts blood supply to the femoral head
  2. extracapsular - less difficult to treat as femoral head blood supply is not compromised
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18
Q

what is a type of intracapsular fracture?

A

a femoral neck fracture

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19
Q

How many types of neck femur fracture are there ?

A

4
* they follow the garden fracture grading system

20
Q

Describe a garden I fracture

A
  • incomplete fracture with valgus impaction (ie broken bone pointing laterally)
21
Q

Describe a garden II fracture

A
  • complete fracture without displacement
22
Q

Describe garden III fracture

A
  • complete fracture with partial displacement
23
Q

Describe a garden IV fracture

A
  • a complete fracture with total displacement
24
Q

how would a garden type I or II fracture be managed?

A
  • early protected weight bearing is allowed WITH CAUTION
  • use pain as a guide for management
  • if it is undetected - there is a risk of later displacement days or even weeks after initial injury
25
Q

how would a garden III or IV fracture be managed?

A
  • ORIF
  • pins or dynamic compression screw and plate
  • protect from WB - ie patient is NWB
  • potentially prosthetic replacement
  • if associated damage to acetabulum - then maybe full hip replacement
26
Q

what are important post op precautions to follow in order to prevent dislocation after a hemi arthroplasty or full arthroplasty of hip?

A
  • avoid hip flexion beyond 90 degrees
  • no crossing operated legs - as that would be adducting - which can lead to dislocation
  • no twitsing from your hips
  • dont turn your operated leg inward
  • for around 6 weeks post OP
27
Q

what are possible complications that can occur with a femoral neck fracture?

A
  • avascular necrosis
  • non union
  • loosening of prosthesis
  • collapse of femoral head with dynamic hip screw
  • post op symptoms eg confusion, UTIs, pressure sores etc - higher risk if elderly
28
Q

what is the cumulative ambulation score? (CAS)

A
  • a score used for daily assessment of developments in basic mobility until independent ambulation is reached (ie can be mobile without assistance)
  • consists of 3 activities - getting in and out of bed, sit to stand from a chair and walking
  • each activity is scored from 0-2
29
Q

define the term** ambulation**

A
  • the ability to walk **without the need of any kind of assistance **
30
Q

CASE STUDY

a 74 year old female falls at home and sustains a right garden III fracture. She recieved a right hemi arthroplasty and her post op instructions say that she can PWB… what are the discharge goals for physiotherapy and outline generic post op plan to achieve these goals

A
  1. discharge goals - ideally discharge after 3 days, we would want her to be as** independent as poss with bed and chair transfers** and we would want her to be able to walk 10-15m with a walking frame
  2. generic post op instructions
    * sit to stand practice
    * walking practice with zimmer frame
    * educate her on how to use walking aid, ie using her hands and pushing her off chair, teaching her how to turn etc
    * practing transfers - lying in supine position to sitting up etc
31
Q

what are 3 examples of extracapsular fractures or trochanteric fractures?

A
  • inter-trochanteric - ie between the trochanters
  • sub - tranchanteric - below the trochanters
  • avulsion greater trochanter - ie a piece of bone gets pulled off
32
Q

Describe an intertrochanteric fracture

ie MOI, elderly vs young, treatment - surgery?

A
  • extracapsular fracture
  • MOI - sharp twisting injury
  • heals well and AVN is rare
  • if elderly - there may or may not be osteoporisis
  • if younger - more trauma
  • unstable fracture so it requires ORIF
33
Q

Describe a subtrochanteric fracture

where does it occur? what can it be assocated with? treatment?

A
  • occurs between the lesser trochanter and the adjacent proximal 1/3 femoral shaft
  • rare
  • may be associated with disease or pathology
  • treatment involves ORIF
34
Q

what group of muscles attah onto the greater trochanter?

A

the ABDUCTORS - eg gluteus medius, minimus, obturator internis etc

35
Q

Descrie a avulson of the greater trochanter

MOi?, what movements are sore? treatment?

remember avulsion - bones gets pulled off

A
  • a violent adduction strain can cause this
  • severe localised pain
  • abduction is painful
  • treatment involves bed rest and then progressive WB with crutches
36
Q

what MOI can cause a fracture of the shaft of the femur?

A
  • considerbly violent RTA
  • fall from height
  • direct blow to flexed knee
37
Q

what types of fractures can a fracture of the shaft be?

A
  • spiral
  • transverse
  • oblique
38
Q

what signs or observations can be seen with a femoral shaft fracture?

A
  • unable to WB
  • considerable fluid and blood loss
  • leg sits in external rotation and abducted position
  • thight appears short and fat
39
Q

what are potential complications of a femoral shaft fracture?

A
  • haemorrhage
  • infection if its an open fracture (ie protruding through skin)
  • non union
  • mal union
  • arterial and nerve injury
  • fat embolism
40
Q

what does the immediate management of a femur shaft fracture involve?

A
  • restore blood and fluid volume
  • if the fractue is open, then clean wound and removing debris
  • antibiotics
41
Q

what does the immobilising treatment stage of a femoral shaft fracture involve?

A
  • may involve internal fixation
  • external dixation - ie if its open, unstable, in an emergency situation
  • long leg cast
42
Q

what is an ilizarov frame?

A
  • special type of external fixator
  • used for limb lengthening
  • correction of bone deformity
43
Q

what can a brace be used for?

A
  • may be used after external fixation
  • allows hip and knee ROM
44
Q

what is a fat embolism?

A

occurs when a small bit of fat enters the blood stream and can block blood flow

45
Q

what are the key clinical signs of fat embolism that can happen 2/3 days after a bone break?

A
  • trouble breathing
  • fast heartbeat
  • mental state changes
  • vision changes
  • jaundice
  • fever
  • rash
46
Q

what is a quadricep lag?

A
  • the patient cannot fully actively extend the knee, but it can be passively extended by the clinician

NMSK1 - physio 1 (36 decks)

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