Ortho Flashcards
(16 cards)
What determines the stability of the spine?
Bony Configuration of bones involved
Ligaments connecting them
The muscles
What would make a spinal injury unstable?
When noth posterior and anterior elements have been injured at the same time.
What would make a spinal injury stable?
When either the posterior or anterior aspect has been injured
What is an extension force?
*It’s usually in the cervical stone,where there is fractured of the anteriorinferior aspect of the spine(tear drop fracture) due to flexion
-It’s a stable fracture
-Posterior aspect intact
What is a compression force?
Usually the lumbar or cervical
-Burst fracture-encroachment oder spinal canal
-posterior elements intact
-stable
How can you manage a pt who experienced flexion/extention injuries?
They are usually on bed rest in traction:Start with co contraction of the muscles and then gradually progress to isometric exercises and bed maintenance exercises and gradually adding resistance within pt pain limits.
What to do with the cervical collar?
If it’s a flexion injury-emphasize extension exercises within collar limits, and the opposite is true with extention type injuries
How do you manage a patient with a collar?
Wean off dependence of the collar and remove it for longer and longer periods of the day
-Start with gradual movements of the cx spine then gradually return to full range and stretch the muscles
How to manage a pt with a compression injury?
Without neurological involvement, then Rx is the same as flexion/extension injuries
How to manage a pt with an anterior compression of the cord?
-Assessing any motor deficits,tendon reflexes, and proprioception
- Monitor progress of swelling of the cord
-Active movements with uninvolved areas and passive movements with paralyzed areas
-exercise-Treat as unstable with internal fixation
-Prompt optimal functional return
How to manage a pt in traction?
-Provide a mirror
-Avoid rotating neck,and also turning should be done with assistance of a log roll
-Co contraction of Cx spine
-avoid side flexion(arm movement above 90 degrees and should be bilateral)
-bridging for bed pan use and shoulder girdle should be fixed by pushing down on elbows and limit transfer of neck
-Wean off the brace -Active mobilization of neck working from and stretch of muscles which have shortened or developed trigger points
How to manage pt in brace?
Raise head gradually to allow circulation to adapt because dizziness is usually serve for first two days.
-Rhythmical stabilization in sitting and standing to regain balance
-posture is important
-isometric exercises should be taught ti maintain strength of muscles
How do you treat stable thoracolumbar injuries?-One bed rest
No straight leg raise
-Bed pan-Log roll into SL flex the knees at 90 degrees and position pillow longitudinally behind thorax and head with bed pan at the bottom and line pillows push pan down on mattress as pt log rolls
-Caution with pelvic tilt
How to manage a pt with a brace?
Teach pt how to put brace on and how to get out of bed without sitting
-Wean from corset and start with gentle active spinal movements to be progressed gradually
-Gait re education
How to treat pt with unstable thoracolumbar injury?(bedrest)
-Exercise
-avoid trunk flexion or rotation or SL
-avoid prone for extention type injuries
-Bilateral abduction/add of hips (start with small range the increase to full range within strength and pain free range)+
How to manage pt with a TLSO?
Teach pt to apply brace in lying
-Wean off gradually
-gentle active movements of spine
